I've mentioned this elsewhere, but having gone through long, severe periods of depression, I'm convinced that seeking help needs to be declarative, not procedural. One shouldn't have to go through the multi-step process of:
1) Deciding whether or not treatment would be helpful.
2) Figuring out what sort of professional would be best: psychologist, therapist, psychiatrist, social worker, etc.
3) Wondering whether your choice of professional will influence the type of outcome you desire. For e.g. a psychiatrist is likely to prescribe meds while other professionals may prefer mindfulness, CBT, talk therapy, etc.
4) "Will they throw me into a mental hospital? I want to lead a normal life, I'm not one of those people!"
5) "Is it covered by insurance? How much will it cost?"
6) "How can I find a good professional? I've heard there are a bunch of shitty ones. I need a good one."
7) "I'm too scared to even pick up the phone. How do I determine availability? Can I schedule this online?"
8) etc, etc, etc.
This is something that needs to be solved with an online questionnaire that spits out an appointment time and location at the end. Telling depressed people to go through the aforementioned steps is like telling someone with a broken leg to just walk to the hospital that's a couple miles away.
To the OP: my suggestion is to Google around, find 3 people who accept your insurance or are affordable out-of-pocket, pick one, and make an appointment. It's 10x more important to make an appt, any appt, and go than it is to worry about finding the best person. You don't have to stick with the first person you see anyway. If you're still overwhelmed, I've found the average PsyD to be better than the average therapist/social worker.
I agree with you that it's important to find a therapist that "clicks" with you, but I'm convinced that taking the first step and making an appointment is the hardest part. An order of magnitude harder than making a second or third appointment. Therefore, I think the most important problem in mental health is getting people through the front door and sitting in someone's office.
I think the concerns could be harmonized with the OP by simply spitting out, "Here are 5 people to call" with perhaps a little info on their approach. This could of course link to a description of what those approaches mean, i.e. "CBT seeks to change mental habits in the moment by teaching tools to rethink and process reactions as they happen" etc.
Completely agree with this, and will even say that the weird thing about mental health is that you may not even be able to trust your own judgment, since that's the part thats sick.
A few years ago, I had decided on my own that I needed medication; the depression was so overwhelming that I felt like the problem had to be chemical, and no "touchy-feely" talking therapy could possibly help. I went to a few psychiatrists, with varying degrees of success (I caught one reading side effects of a medication off of wikipedia) and stopped going several times because I felt like it wasnt helping. It was only when things got bad that I found a therapist (I think I just googled "therapist <my neighborhood>") -- who I liked -- and she convinced me to just give her way a try. It worked.
I am on medication again, and its helping, but it was really the therapy that I was so against thats making the biggest difference. All of this is to say that find someone you like, and then be open. Deciding how you want to be treated from the outset doesn't necessarily make sense. Mental health issues are like any other illness -- we go to doctors for their advice and expertise. But you need to go.
Want to strongly re-affirm the fact that you should tell them you're exploring multiple therapists, and that you SHOULD try a few. Each therapist has a different style, and therapy is not a formula that everyone just "implements". Being able to form a connection with your therapist is very important, and while you might pick the right one off the bat, trying a few will help you pick the right one for you.
I'm really not kidding. The range of usefulness of therapists is so large that "any therapist is a good starting point" usually works. It's better when you can ask friends, but if you can't, any therapist will do.
I work in the mental health space (we make practice management systems for therapists) and I couldn’t disagree more. The quality of therapists varies so widely that frankly some of them, I can’t imagine how they ever got licensed.
As a person who recently had to do this, my suggestion would be to find someone close to either your home or work. Next would be to find someone of the gender you prefer (I prefer same-sex), then find someone in the age group you're in. I've had good luck using this heuristic to whittle down the list to a few names.
Then go for a brief session with each of them. You should pick the person you feel most comfortable talking to EASILY. This person should be someone you don't feel judged or threatened by. You should be able to understand them clearly and they you.
Think about it like it's a date. In a way, it kinda is.
Indeed, you both have to click, as a therapist, I won't receive anyone I feel I couldn't work with sincerely (no judging and lovingly). In those cases I would always recommend someone I feel would be better suited.
It’s even a rare glimpse of motivational catalysis that a depressed person can muster up the activation energy to reach out for help and assistance. Agree with you that these steps often cause the person to lose that fleeting motivation.
Fwiw I’m fortunate that many friends are open with me that they are/have been seeing s professional. So I would go to them for a referral. As one good friend put it, “we get help for our bodies, so why not our minds?”
The best website that I've found that begins to fit this is Zencare. Entered what I was looking for, got a group of practitioners that have videos available so I get a bit of a feel for them, and I scheduled a phone consultation immediately through the website. Its currently regionally limited (RI, MA and NY) unfortunately.
I've since moved out of the area though and have been trying to find a replacement and its been such a painful experience.
Thank you for this suggestion. It's the closest I've seen to far to a solution. A sad shortage of providers who take my insurance, but the UI made it otherwise easy to narrow down to a manageable number of options.
> This is something that needs to be solved with an online questionnaire that spits out an appointment time and location at the end.
My brother just got some (charitable) funding to develop an app to do exactly this! Very early stages of the project so it's hard to say how well it will go but his hope is to solve exactly the problem you're talking about. (I might be helping to develop the app, depending on scheduling.)
Only just saw this! Feel free to email me at the email address mentioned on the webpage that my profile links to and I'll get back to you. (I don't really check the email address mentioned on my profile itself.)
My little company built such a thing but YC and others like them are very disinterested; it’s very hard to get traction for something like that because you are looking at millions of dollars in marketing before there is enough of a network effect to become useful.
And is also a very subjective market. A great therapist might be the worst for someone. I know of a few initiatives like this in Spain a few years ago, and the review/recommendations system always felt clunky.
Besides, some schools of therapy would think the expectations of a patient that expects you deliver a 5/5 stars therapy, would taint the natural therapy process.
Yes, exactly. I wish I could pop my location and insurance plan into a website, and get back a list of 3 nearby providers who are accepting new patients - even better, links to a site where one can schedule appointsments with each of them.
Google, however, is prohibitive. You end up having to either comb through thousands of individual results to find ones that are nearby and take your insurance, or you end up on an aggregator site with literally thousands (at least in NYC) of matches and the same problem with slightly more structured data.
It's just so daunting to make any decision when faced with too much data and insufficient information on how to use that data, that the depressive brain just kind of shuts down and says "fuck it, I can't deal with this now."
Not sure if you are in the US, but Zocdoc does exactly that thing. Enter location, doctor type and insurance, it will show you the list of all doctors/therapists and you can even sort by rating and availability.
I think its important to take any action, make an appointment with ANY doctor, don't stop yourself because it might be the wrong one.
I researched bio's for months before making an appointment. I picked the one person in Vegas that had the experience I was looking for with "Mindfulness Techniques, Neurofeedback, Transcranial Magnetic Stimulation"....
Even though that was what he was expert at, he let me know that those services were not what I needed at that point. After getting actual medications to stabilize, I was in a much better position to try the more hippy-esque treatments and go from ok to happy.
So really trust doctors to get you where you need to go... especially if they have good reviews on ZocDoc (Damnit... I'm doing it again).
> yeah because a treatment that might induce a seizure is just what one needs.
For some patients, a treatment that does exactly induce a seizure (i.e. ECT) is what they need. Of course, because of the risk of harm, it's still reserved as something of a last resort and only for particularly severe cases.
I'm pretty sure rTMS has nowhere near the same risk profile, even in the reported cases where seizure did occur.
> do research and be extremely wary of anything hyped
I would offer the same advice for anything that is hyped against with scare tactics, if not just, more broadly, any proposed medical treatment.
This is something I'm trying to solve, starting with Australia. I'm building the service that I wish existed when I needed a mental health professional, something I can send friends and colleagues to.
It does a lot of what you suggest. I've started from a position of "so you know you want a psychologist" because otherwise the scope is just overwhelming.
Like people have found, fit is the most difficult thing. I think we can improve this with data. But until someone's figured it out, I recommend always calling a therapist on the phone and talking to them a bit, before committing to a session. The phone is scary, but a bad intro call is much less draining and expensive than a bad session.
We're working on enabling online appointment scheduling for the reasons you say, but getting a uniform booking interface for thousands of individual psychologists turns out to be a huge task.
If people wanted to have a look around we have a test link  so the human clinical staff know that you don't need help.
I'm piggybacking on your comment to ask whether anyone has tried any of the remote counseling/therapy services available. There are several (Betterment, Modern Therapy, etc), the prices are transparent (though not cheap), and it's easy to schedule an appointment and pay despite insurance not being accepted for most.
Does anyone actually have any experience with these services, and were they effective?
No, don't do online therapy. For one, it costs the same as in person. But most importantly, the way a good therapist works is by reflecting and empathizing with you. And this is only effective when you are in a room together, their focus is on you, you don't have distractions, and you see their face and hear their voice. The content of their words is secondary. It's all about developing a human connection and opening up.
Even the process of getting up, driving to their office, writing the check, the fact that you have to be on time and have only this one window of time to talk, it all matters because it's a series of tangible steps you're completing for your own self improvement. The computer elides all of this in the name of "convenience"
I don't have any experience with them, so I can't say for sure, but I personally believe much of the benefit comes from seeing someone in person. I can't fully describe why, but I think it has to do with the bandwidth needed to convey mental health issues. That being said, I think any therapy is better than no therapy, so if the choice is between a remote service or nothing, pick the remote service.
Got an opinion based on zero experience and can't explain it but you'll guess anyway? Two can play that game:
I guess that phone and videochat have the necessary "bandwidth" to convey mental issues. After all, people talk for hours via phone or videochat about their lives and problems. And the availability and convenience these media enable helps address the ancestor comment about the difficulty of seeking treatment.
I'm on mediCal so I get pretty much one option for mental health, these 'family clinics' and goddamn they are horrible. I've been in one of the deepest depressive swings I've ever dealt with and they really couldn't give less of a shit, but I can't see a normal doctor without paying out of pocket. It's kafka-esque, really.
If you have the need to talk to someone, you can find low cost Therapists.
They are usually students, but I found they were better than the licensed MFCC, and PhDs. The sessions are recorded, and listened to by a licensed therapist.
I believe most medi-cal doctors will prescribe antidepressants. Yes--the medi-Cal system is not great. The drug formulary is workable though. There are some very good medi-cal doctors though. They don't have the much time with the patients, but if you go in with depressive symptoms they will prescribe. A nurse might give you a depression screening. They never worked for myself, but I was told I'm not really depressed. And as my doctor always said, "All my patients are different."
The average medi-cal doctor writes prescriptions for psychotropic drugs daily.
Hang in there. I don't know your age, but the twenties/thirties are a bitch. Just a cluster puck of hormones, expectations, etc.
Don't let this society drive you nuts. The economy is suspose to be blissful. I don't see it. I just see the wealthy getting ahead. I notice so many very unhappy people. We are at a weird time in history?
If I had a do-over, I don't think I would have tried so many anti-depressants. I fell for the advertising. But--but, I'm no Psychiatrist.
Oh yea, too much alcohol can make depressive symptoms worse. I'm not preaching, but I know first hand.
(A bit off topic, but sometimes not having great insurance is not a bad thing in the long run. I have met a few people with good insurance that are vastly overmedicated.)
Isn't the conclusion here that "mindfulness" is ill defined rather than "just run"? Mindfulness in its most serious form seems to basically be a form of CBT, which may have its own criticisms but at least isn't total snake oil. I don't know about you, but I'm rarely focused on a CBT style practice when running or doing yoga -- they seem to be very different kinds of activity.
I often offer up my therapist's practice as a recommendation to friends.
The way I think about it, all you really need to do is:
1) Call someone, anyone, to make an appointment
2) Meet with them, ask lots of questions. There will usually be an intake process that takes a lot of time but will give you some answers as to what kind of issues you want to work on.
3) Start talking to someone regularly. If you don't feel like it's worth it after a while, consider finding a different therapist. For me, just having someone, anyone, to talk to things about felt great right away, even if it didn't "fix" anything.
Since you're in a big city with lots of options, try to find somewhere that is convenient for you to get to every week (near work or home) and just make the call. I would recommend just starting with a therapist at first, and if you think you want to pursue medication, you can ask them for a recommendation for someone to prescribe you medication.
If your GP can't offer you a referral, honestly the best you can really do is just pick a psychiatrist or psychologist nearby who accepts your insurance. Either can diagnose you if there is something to be diagnosed. Both can offer therapy, only psychiatrists can proscribe medication.
If you end up doing therapy and don't feel like it's working with that professional after a few sessions, they should be able to refer you to other psych* or therapists. In this case there's no hard feelings, most psych professionals will be the first to tell you that not all patients will click with all therapists.
If you live in Seattle, I can recommend the Women's Therapy Referral Service. It's not just for women patients — just the therapists are all women. The nice thing is they give you three therapists to have a session with, and you can choose one to continue with (or not).
Just one note regarding insurance and cost. I think the number of therapists that are covered under insurance plans varies dramatically region to region. The bay area, as an example, seems to have an incredibly small number of therapists that are in-network on insurance plans. It seems like the majority of psychologists do not work directly with insurance companies, because there's so much demand and the insurance companies are such a hassle and pay so much less than market rate.
The market rate for a therapist these days is something like $250/hour here in the bay area. Many insurance plans will reimburse if you submit an invoice from a therapist. The reimbursement rates vary greatly, sometimes zero, sometimes 50%, sometimes 80%, etc.
So all that to say that it's a super shitty system where you can't know ahead of time how expensive therapy will end up being for you, and the therapists themselves typically also don't know ahead of time (although they can certainly have a sense of which insurance companies typically reimburse at different rates).
Source: my wife is a psychologist in SF who doesn't directly accept insurance but the majority of her patients receive some level of insurance reimbursement.
If you could say what city (and country) you are in, it might make it easier to give recommendations instead of having a completely abstract discussion :)
I've worked as an emergency medicine doctor in the UK and the US, and in the US at least, I tend to recommend that patients with less severe symptoms start with a therapist (i.e. NOT someone who can prescribe meds). If the therapist really thinks a patient needs meds, they can arrange a referral to a psychiatrist, but I feel like psychiatrists underemphasize the therapeutic values of actually talking to patients and overemphasize meds.
Now the meds are absolutely required for some people with more severe conditions, and can help those patients a lot, but for the majority of people who have less severe illness, I think they can do more harm than good. Either way, a therapist can tell if someone does need meds and make the referral if needed, but the extra level of indirection is helpful, I believe, in preventing over-medication.
Well, over the weekend I wrote up a bit about my struggle with burnout and mental health. I got about a bajillion fake internet points for my comments so I guess people wanted to know what I have to say. I’ll go ahead and add a bit about how to find a mental health professional. I hope it helps a bit
First, if your general practitioner doesn’t have even one suggestion at all, I’d suggest thinking about a new general practitioner. This is quite like saying “my leg has fallen off can you put it back on?” And your doctor saying “well I can’t and I don’t really know anyone who can. Have you tried google?” If that sounds absurd, it’s because it is. Mental health is important.
Second, if you love your GP, try asking around other people you know. Ask on Facebook or twitter or LinkedIn for your friends recommendations. Don’t be embarrassed. Mental health is important.
If you are a member of a religious or social organization, ask the leaders of that. Almost invariably religious leaders have good recommendations. They talk to a lot of people and often have a good understanding of mental health issues and who can solve them.
You can also ask your insurance. Insurance companies often have a referral service. It won’t be as personalized but it will have some help.
Now once you hit up all these groups then make a list of 5-10 therapists and call them. Have a few minutes phone conversation. See what they are like. Then make an appointment.
Whatever you do, please don’t give up on finding someone. It will help. It’s a good thing.
People without gov issued health insurance don't know the pain of bouncing from shitty doctor to shitty doctor. They see so many worse cases than you every day, 'sad gringo probably should off himself, the ingrateful lout' is the attitude you get when you try to discuss your problems. Have fun explaining the depth of your issues in a 2 minute pitch!!
If you feel you would benefit from talking to someone, the type of person you want to seek out is a therapist. Therapists can then help you decide whether you should also be seeing a psychiatrist for medications.
As for narrowing down therapists, take that list of ones that accept your insurance and cull the list of therapists and offices with poor reviews.
I would have a list of a few therapists that meet your criteria (located close, covered by insurance, etc). If you don’t feel like you click with the first therapist you see, visit another one. It’s important that you feel comfortable with your therapist, and don’t give up your hunt after one bad appointment or match.
Unfortunately you may need to just try a few and see who you click with. It's not uncommon to do a preliminary session with one and either they decide to refer you to someone else (based on your situation) or you just don't like them. This is why it's hard to go by reviews from other patients.
Sometimes your employer offers a service called an EAP (Employee Assistance Program) that can direct you to resources that are covered by your insurance.
Finding a good therapist is really a bit of trial and error. Put yourself out there. See someone and do a gut-check. A therapist should work to establish a trust relationship and you should feel listened to. If they make you uncomfortable or you think they will never be someone you can open up to, it's probably not the right fit.
Full disclosure: I work at a company called Ginger.io that provides 24x7 coach chat support and video therapy/psych sessions using a smartphone app. We work with employers to provide services for their employees as a perk. Some of our employer clients fully cover the cost of psychology and therapy, and for others insurance covers our cost.
We make the set up process a bit more straightforward. We match you with a care team, and make it easy to change it up if it's not the right fit.
The good news is you went to your GP and typed up a request on Hacker News. Some more good news is that in many cases depression is more of a life-state issue than a neurochemistry issue (1). Further good news is that it can often be resolved by talking to just about anyone. Finding the optimal therapist is far less important than talking to some therapist.
There are a few advantages to talking to a licensed psychotherapist (clinical psychologist, psychiatrist, etc): 1) they are bound by therapist-client privilege; 2) in order to have gained licensure, they had to go through a training process where they built a network of other professionals, not just their own inbred type, but pharmacists, physicians, etc; 3) because they're licensed they want to protect their license, so they will have a low threshold to refer you to a colleague if they believe you need more than they can provide.
Note, absolutely none of that has to do with their skills, their belief system, or anything else. It's strictly to do with the rules that apply to that piece of talking meat.
Given that talking with any piece of meat is better than not, I'd encourage you to talk with a piece of meat that is subject to some social rules that strongly encourage them to make sure you get the best care.
I needed a therapist about 5 years ago to deal w/ a specific event in my life, and I asked my mom that question. She's a former therapist, and she taught me a couple tips on how to find a good one. Instead of passing those tips on to you, I suspect the advice might be different for each person, my suggestion is to call a therapist that looks legit outside of your local area and how they'd find a therapist. Also ask a couple questions about what you can realistically expect in therapy, as you're likely going to discover it's much different that you expected.
Also, you don't have to limit yourself to providers that accept your insurance, as many do not. My therapist didn't, and she only worked on a cash basis. I manually submitted claims to my insurance for out of network therapy services, and was reimbursed later. Some insurance plans have an out of pocket maximum for that applies to all expenses, both in network and out of network. If that is the case, and your out of pocket maximum is $5K, then everything above that is "free"!
For me, therapy was the best $10K I ever spent in my life. It changed everything, but I had to work my ass off to make those changes. I hope you find success on your journey for more awesomeness in your life.
I wish the comments here that suggest resources could also provide an amount of privacy protection the various apps and sites listed have. It's hard to tell who is keeping data for others with these various portals.
I also wish the psychtoday and healthgrades and others would actually call the places listed in their pages, maybe an hour before closing listed hours, and leave a message asking to be called back instructing them that leaving a message or text is okay.
In my recent experience using some of the methods suggested by others here to find help for a friend in this growing city, not 1 of the twenty or so places that I called answered the phone or returned a voicemail.
Maybe they are overwhelmed and not accepting new patients, maybe they heard the willing to pay cash no insurance and decided not to return a call - but this kind of data I think is more important for this kind of a directory than say a listing of car repair shops.
Reading many of the comments here, I think it's fair to say that it's not as easy as it should be in many places to get help.
I read an article recently saying some places may be coming out with a new type of practitioner class that doesn't take the decade to get license and that may provide more help in the future, but it also seems that more help will be needed.
The Mood Notes app will ask you how you are feeling, why you think you may be feeling that way, and whether any thinking traps may apply to that situation. Finally, it will ask whether you feel any better after having reflected. You could do the same thing without the app, but the app helps to formalize the process.
Reduce phone, computer, and television usage as much as you can.
Slow down. Go for walks. Put less pressure on yourself. Tell yourself that you are OK, and everything will be OK. Breathe.
1) You look up your health insurance to check how you're insured. (Ideally, you try to extra insure at end of year for whatever you think is necessary but it is almost always never a net profit, or extremely small.)
2) Then you call up your doctor for an appointment. If you think your discussion with your doctor requires extra time, tell that to the assistant.
3) You go visit your doctor and explain the problem(s) you have. He/she'll likely give you a reference for a psychologist/psychiatrist (latter if you are interested in using drugs such as anti depressants). This reference is important for insurance reasons.
This is where the advice from me actually ends since I'm not your doctor! You have found a mental health professional. From there, you can work out which treatment you want, or get directed towards more/other professionals (I gave some examples). One last piece of advice. Avoid all the paranormal BS. Stick with conventional science (mindfulness is conventional science, btw).
Pick a friend you can trust and ask them to handle the whole thing, including driving you to the first few sessions. If you're depressed any bit of extra effort can derail your treatment, so don't tempt the fate.
Doesn't have to be a close friend, just someone responsible. Perhaps try a parent with grown children - they would understand responsibility and have time for you.
--Example 1: The decision was made for me
The therapist I went to after my suicide attempt was an uncaring, unsympathetic bitch. (yes, I know I'm gonna get kicked out of the feminist club.) I went to her only because the hospital staff released me after I said I would see someone and the appointment was made. And let me digress a minute. The ER staff (Inova Alexandria, Virginia) were even worse. They told me I was silly and unfeeling and totally wasting their time, that there were people with real problems there and I was taking time away from them. I kid you not. Back to the mean therapist. I only saw her a few times.
--Example 2: My doctor made a recommendation
I diagnosed myself with clinical depression (I took a quiz in Good Housekeeping but I had know for 20+ years that something was wrong with me) and went to see my GP. In the appt with my GP, I disclosed I had been molested and he recommended I see this woman (I have no idea what her degree was, it didn't matter then). He warned me she was a little touchy feely (not in that way!) but told me to stick with her for a few sessions. The doctor was right. My therapist was wonderful and got me through one helluva hard time.
--Example 3: My new NP made a suggestion
I'm not in the mood for therapy therapy so talked with my NP and she suggested a local clinic type of thing. She described what it's like, told me she visited several times, and has referred other patients there. All are getting something out of it.
I've done pretty well getting recommendations/suggestions save for the crazy b in Alexandria, VA. As a networker, I feel confident I could find someone by asking around. BUT ONLY if I were not in crisis mode. If I need an emergency sort of thing, my plan is to call my NP (I have her mobile) and her tell me where to go when.
I do agree with the too many options comments. I have thought about just checking myself in somewhere. THAT is a challenge. Is A better than B? Etc.
What helped me narrow down my options was how easily I could fit a visit into my schedule. Because once you lower the barrier of visiting a therapist, the more likely it is that you'll continue seeing them. Maybe find ones that on the same route to work?
After that it's trial and error. The process almost mimics anti-depressant medication. If you don't feel comfortable with the one you've got, move on to another. That comfort factor is purely qualitative and you can only find the therapist that works for you after wading through a few that don't.
I haven't found mine yet but good luck to you in finding the help you're seeking..
Also, feel free to reach out to me if you want to talk and need a sympathetic ear.
Like others, I had a hard time finding a therapist to deal with my anxiety. My 6 month search added more stress to my life — I didn’t know where to go or what to look for.
My frustration led me to talk to 200+ clients and therapists to learn more about how this should work. I ultimately started a company to solve this exact issue using my research (www.joinreflect.com).
Lots of great comments already, so I’ll just add a few things I learned if helpful:
1. According to the research, the biggest predictor of success in therapy is fit (who you “click” with). There’s no right therapist for everyone. I suggest first thinking about why you’re looking and what style of work you might be interested in (e.g., do you want to talk through issues or find a solution/change behavior?)
2. Definitely review profiles/websites and see what the specific clinician has experience with
3. Orientation is a helpful filter to predict style, but it’s not nearly as rigid as you may think. In reality, many therapists say they’re “client centered” and can flow between orientations (e.g., CBT vs. psychodynamic). Some specialities are more evidence-based than others (in academic setting), but again, fit is most important
4. There’s little practical difference between degree type if you’re looking for talk therapy (MDs can prescribe medicine, doctorate level can do assessments, associates are under supervision of a licensed clinician)
5. Many therapists offer free 15 min calls to try, so def take advantage of those (2-3 usually works if you have a targeted list). In the calls, ask specifically how the therapist might work with you to treat the issue(s) and see if the style matches what you feel comfortable with. Note, you might have to call a bunch to even get 2-3 on the phone, especially if you want to use insurance as many providers are full
Figuring out #1 can be hard. I started reflect (www.joinreflect.com) to use my research to help others. reflect is live in the Bay Area, so check us out if you’re here. We match you with therapists well suited to your needs based on an algorithm I developed, and you can try each for free. 90% of those who do find a therapist they like, and we have the largest self-pay network of therapists in the Bay Area with ~300 clinicians and growing. In-person sessions are $95, and you can use out-of-network insurance and HSA/FSA.
Even if you’re not in the Bay, feel free to email email@example.com. I’m the founder, so either I or someone on my team will get back to you ASAP. We’d love to help any way we can. Good luck!
Speaking from (successful) experiences with therapy:
For me the key to having success with therapy is to do your due diligence with respect to cost and personal fit ahead of time. At some point in my previous attempts at therapy it became work, and because of fit and/or cost issues with my therapist it was easy to convince myself to not go.
I’ve had a lot of success with my most recent attempt. Assuming you are in the US be warned that the mental health system is awful and finding a therapist is going to take some work.
0) Figure out what kind of treatment you are seeking. Talk therapy is a good place to start IMO if what you’re experiencing isn’t unbearable and not very longstanding.
1) Start with your insurance. This greatly limits your options because mental health caregivers get paid less when accepting insurance than with patients paying out of pocket, but it makes treatment very affordable to you.
2) Find a professional with an office you can easily get to during the week. This is another cost dimension and you want to make it as easy as possible for yourself to stick with it.
3) If you found someone that seems promising, ask for a short call to introduce yourself and get pick the caregiver’s brain on their approach to treatment. Make sure it’s something you can buy into and feel good about. Think about goals, preferences w/r/t medication, etc.
Good luck. You may want to narrow it down to just psychiatrists who can see you almost immediately. They can prescribe medicine if they feel it is necessary.
I went this route and despite having decent insurance, every place that took it was a 3-6 month wait for new patients. This is very disheartening to someone who wants to get better but can't even imagine what 3-6 months down the line looks like (have I killed myself yet? did I skip town? etc.)
(This was a past experience, I'm no longer depressed)
If you live in SF, Two Chairs could be a good option (https://www.twochairs.com/). They're a practice which strongly emphasizes the therapist matching component – and as others have noted, finding a proper fit is hugely important for treatment. Not sure if they're in other cities.
Disclaimer: no personal connection, but have heard very good things from friends.
This probably doesn't help OP but might help a reader who's facing the same logjam and qualifies: see if your employer (or a family member's) offers a benefit through https://www.lyrahealth.com/ . It is a super streamlined process that takes all the pain away of triaging what's going on and figuring out which type of provider to use, and then selecting one. I got it through my wife's employer even though I'm not on her medical insurance. There's a diagnostic survey, then they suggest some providers (with a strong default choice, which makes a huge difference), and even help you draft the appointment request email. And they follow up to make sure you get help. It still feels like you're owning the request for help, which is pretty important -- it just puts the whole process on rails.
Depression can take away your ability to complete any of the above steps... I know because I didn't get help for years because of the (minor, but thanks to depression, major) hurdle of finding a suitable provider through my work benefits.
Having a friend who's a "shrink" (her words not mine), this is what I suggest.
First, I recommend a neutral therapist, i.e. one that's not affiliated with a church or religion. I would also recommend getting one that's licensed, or working under the supervision of a licensed psychologist.
Then they are basically going to fall into two categories: Cognitive Behavioral, and Psychodynamic.
Cognitive Behavioral seeks to change your thinking patterns through conscious awareness and behavior modification. Usually there is a limit, say 6-10 sessions with a series of goals to be met.
Psychodynamic seeks to help by helping you to overcome the emotions you may be repressing or unable to deal with. This can be two or three sessions, say or longer (months).
A psychiatrist may do either, and then may add a drug regimen to help you balance your emotions.
All are popular, all work for different people.
Also pretty much all of them will be willing to meet with you to see if you click and answer any questions, though some may not be able take on new clients.
Edited to add:
Also, one thing my shrink friend complains about are "corporate" mental health centers who declare the patient healed when their insurance runs out.
Navigating the mental health care system in this country is difficult. From what you've described, here's what I would do:
- Start with an in-network therapist. My personal bias is to look for someone with a PhD in clinical psychology, but the important thing is to get started. Talk with your therapist about medication. They are trained to do this and to get you do an MD (psychiatrist) if you agree it makes sense. They will take it from there. Managing meds is basically what they do. (There are psychiatrists who also do talk therapy. If they are good at both, it won't be cheap).
- Do not feel at all obligated to stick with your first provider. This part is hard, due to the awkwardness of firing your therapist. Therapy takes time, but it may be clear after a couple of sessions that you are, e.g., with someone who won't talk about solving practical problems and only wants to talk about your upbringing, or the other way around. If you think it might be a good fit, give it more time, but it's true: you do have to click with your therapist for it to really work, and there is no formula for that.
- If you are not a danger to yourself or anyone else, and you are able to take care of yourself (basic social functioning and providing for yourself), then consider thinking about your care in terms of cost and benefit. If you are having to make excuses to duck out of work, that's stressing you out, and the therapy isn't helping, that's a bad c/b. If it's costing you an arm and a leg, your mind is more important, but that's still a bad c/b.
If you are isolated and in constant pain, strongly consider staying in some sort of care as a safety net, even if you can't find someone with whom you really click.
Before even narrowing down the professionals; I would strongly recommend you to question the nature of your problems and think about the possibility of them being symptoms of underlying physical problems.
Most of the time and for most people the so called mental health issues are only symptoms of chronic health conditions or a bad lifestyle. Digestive issues, auto-immune disorders, hormonal imbalances, vitamin deficiencies, excessive stress/unhappiness, a bad diet and similar conditions are all known to cause "mental health" issues in the mid and long term.
I suggest you to review any other physical conditions you have and definitely see a naturopath/nutritionist or a similar natural health practitioner beside your therapist/psychologist/coach/whatever (if any).
Seeing a naturopath over a mainstream physician is important. As mainstream medicine normalizes many health issues and usually fails to grasp chronic conditions; it usually misses important clues regarding not-so-apparent problems and is prone to declare that you "are fine" and "probably need to see a psychiatrist". That is a way of saying that they have no clue.
The human body is a whole and usually the words of a therapist, or the weird drugs of a psychiatrist fall short on restoring your sanity, according to my experience. Please be very skeptic of the professionals who fail to exhibit a broad knowledge on the human nature/body and the ones who strongly promote a single "magic" method of healing, such as a single drug/herb, or bare conversations, however "empowering", "motivational" or "insightful" they may be.
Let me repeat: Check the hardware first for failures.
If all seems to be fine, and you are fit; you probably need to quit your job/partner/town and seek new company/activities.
I was with United Healthcare at the time. Now I'm on Kaiser but have the same guy. I went onto their website and used their doctor search tool. Looked for a therapist that was close to where I lived. Saw that they probably fit the bill reasonably well.
I called the phone number listed then scheduled a phone appointment to be done with the therapist. The day came, they asked me what I wanted to see them about and I explained. They said, "Alright, we can schedule a first appointment and go from there." Scheduled it - met them. During that process he explained pretty clearly what he expects out of patients and what he will take on. I went through my little story of life and he's like, "Alright, time is about up. Do you want to continue doing this?" I said yes and saw the guy on a regular basis.
When you want to become good at anything, one teacher is never enough. Heck, depending solely in the teachers will not get you where you want to be, the most effort will be on your part. Learn, practice, feedback, etc, repeat.
Similarly, one mental health professional, will not be enough. Heck, trust the wrong one, and you could end up worse.
Try different options so that you start to understand the process. Learn as much as you can from reliable sources. Understand that they are just humans. Help them.
Let’s say that you have the economic resources to pay for various cessions a month or a week. Even that, is not enough for the professional to really understand you. That would not be humanly possible.
Learn. Read. Understand. Discover. Use the tool(the professional), don’t let the tool use you.
If you're depressed because of burnt out and feeling isolated, you might actually not need a mental health professional. Burn out (been there a few times) comes from working too hard too long. Particularly on meaningless things.
What you might actually need is a proper vacation. If your savings allow it, take some time off - like a month or two, or three, or more. Travel somewhere. Meet people as you do.
Also chew a bit on your life priorities. Do you want to stick to participating in the glorified rat race you've been a part of to date, or is there anything else in life (building a family? non-profit work? etc.) you'd rather prioritize?
If you're still not re-energized upon returning from your time off, then seek professional help.
My primary advice would be that therapists/counsellors are NOT all the same. You need to find one who works for you, and it is a very individual thing. Actively plan to try 4 of them, and do 2 paid sessions with each before deciding to continue with one.
Also be aware that IMO some counsellors/therapists are actually bad at their job.... if you get the feeling that something really does not make sense to you, then stop going to them and find someone else.
I've tried many and found a few really good ones and definitely some really bad ones.
It's also true that some were good for a long while but then at some point things changed and they no longer were effective for me, so things can change over time.
It’s a huge Problem! That’s exactly why we just built UMA Health! In NYC only now but expanding soon - we are a marketplace to connect people with therapists, coaches and other mental health pros. -Dave Kerpen, CEO Http://UMAHealth.com
First of all, decide if you would prefer talking with a man or a woman. Just choose what you think would make you more at ease.
Then narrow down to 3-4 names (from google, yellow pages, whatever) by taking in account that you will have to see the person regularly. So not too far from either home or office. Just pick 3-4 names of the appropriate gender in an area you could easily reach once a week during workdays.
Set up a meeting with each. Explain your problem, discuss what option you have.
After the last meeting, review which one gave you the best feeling (assuming more practical consideration - like the fees - are comparable) and pick him/her.
I had a big crisis years ago and thought I need professional help. Finding that help was almost more depressing than the depression I already had. One thing I have learned is that if you have any doubts about the person you are working with, keep looking until you find someone you really trust and get along with. When I looked I was already in a bad situation and had several disappointments that only took me down even more.
I think there are a lot of not very good mental health professionals out there and even among the good ones a lot of them won't be a fit for your personality.
If you are in RI, MA, or NY state, the website https://www.zencare.co/ might work for you. It comprehensively listed all of the mental health professionals near me that were on my insurance provider's search portal, with much richer profile information. I liked it because I could very easily find a professional who specialized in the types of things that I sought care for and who I would likely feel comfortable with based on my reading of their background information.
I used a directory like Psychology Today to find a counselor that ended up being a great fit for me. He was understanding of my situation (in-between jobs) and even gave me a discounted rate. Stay strong.
I've found in many areas (I've moved around a lot) few Drs and therapists are accepting new patients.
I wish I could find a psychiatrist who also does psychotherapy. Psychiatrists are focused on drug maintenance. Finding a good therapist is difficult, and I've almost given up.
I'm moving to a new area, so I will probably start the search over again. I wish I could offer more advice, but I think it comes down to just trying out a few therapists. And make sure they actually listen to you.
I don’t have the answer, but I wish to say this is a very excellent question, because many people think that all therapists or psychiatrists are created equal, and this is so far from being the reality. Most of the therapists or psychiatric professionals I’ve encountered or have had family members deal with, have been, in my experience, quite terrible at what they do. There been a few shining stars, and the rest probably shouldn’t have been in the field.
2 things from someone who just went through this process.
First: if you pick wrong, you haven’t lost much beyond a little time (less than you spent depressed) and a few copays. Set an appointment TODAY, and if it doesn’t work out, pick a different one.
Second, when picking: lots of therapists have a website where they write something about how they approach things. If it sounds plausible, make the appointment. You will know after the first session whether you should book a second one.
Finding therapists is very, very hard. Not only do they have to be good, but they also have to mesh with your style. I've gone through this tiresome process. You need to go in with the attitude that the therapist is going to suck, and that you will have to go through 20 of them before you find the one that's right for you. Lowering your expectations and anticipating a long but ultimately rewarding search is the best way to take it.
I'd like to add, it's okay to consider them "a friend" as long as you keep the context in mind. They're there to help you, so you can rely on them and trust them. You literally can't disappoint them though, that's their job. Although they aren't the kind of "friend" you'd hangout with, etc.
I'm offering this mostly just as a way to put some structure around the problem you're facing, since I feel like I know where you're coming from with this problem. The important thing, I think, is to come up with a plan to move forward even if just a little bit, and then you can iterate. So hopefully this is helpful.
Are you open to medication, or is that something you're trying to keep off the table? If the former, you might want to limit your search to psychiatrists.
There are also the psychiatric equivalent of nurse-practitioners (PMHNPs, I think), who can monitor and alter prescriptions in concert with your GP.
If you go with a psychiatrist or MHNP, you'll probably want to find one that does counseling as well as diagnosis and prescription, which might dramatically shrink the field.
In the alternative, you can meet with a reputable psychiatrist (part of a large practice, or with a degree from a good school) and then get a referral to a counselor.
As counselors go, whether they're the same as your prescribing psych or someone you're referred to, there are a couple big factors you'll want to consider:
* Do they focus on the problem you're actually having (depression and anxiety, it sounds like?) or do they focus primarily on substance abuse or trauma or relationships?
* Do they have a specific therapeutic modality they pursue? Are they a CBT practitioner (behaviorist) or DBT or psychodynamic (PD)? It might be less important which of these things they are and more important that they coherently articulate what they do. (As an HN reader, you might be interested in counselors who do CBT, since CBT is the branch of psychological therapy that seems most evidence-based, but that's probably mostly about your comfort level). Also be aware that treatment modality includes things like "do they do group sessions", which might not be something you're in to.
* Dumb basic stuff like, do you want to talk to someone older or younger, male or female? Are they nearby? Who's got an appointment open convenient for you? You're allowed to maximize your comfort level here.
The most important thing here is, you can meet with a therapist and then make the call about whether you like them. You don't have to get it right the first time.
If you're feeling severely depressed, a reasonable plan might be to find a psychiatrist, get a consult, and then ask them for referrals to counselors. A lot of psychiatrists seem to focus on diagnosis and prescription (which makes sense; they're doctors; your GP doesn't talk to you for an hour about the strep throat they've determined you have), but you don't have to take a prescription to get value out of the consult and some decent referrals.
You can do this the other way around, meeting a therapist and then deciding whether to escalate to a psychiatrist. But if you're paralyzed by options, there are fewer "kinds" of psychiatrists than there are therapists!
Hope that's helpful. Other people here will have better answers, I'm sure.
Therapy wasn't for me. I had a hard time opening up myself to complete strangers. Moreover, you need a lot of sessions to make a difference, which equates to a ton of money. So for years I have been taking meds, which general doctors are happy to prescribe.
Recently I got completely off of it. I know my body well enough to know that I can, so I did. I did it because I was unhappy with how many side effects it had, while not really making me happier... just more level I suppose. I still lacked a desire to do things that I used to love while on meds.
I find that two things really shape how well I feel. 1) sleep. Lots of it, and good quality too. 2) exercise. It helps to have exerted a lot of energy so that sleep is better. If I haven't exercised for that day sleep will be hard which makes more more depressed and work less effectively the next day.
Like others have mentioned, you need to find a therapist that clicks with you.
Prioritize your health over your work. Work 8 hours and no more. If project might get delayed then so be it. Your PM will have to allocate more resources or fire you. Have enough money saved up so that even if you get fired you aren't screwed. If your stress isn't caused by work, then something else, but since you are asking on HN I suppose it is related to work, and the isolation that it brings.
Most therapists do not know the root cause of mental diseases. I recently watched a docuseries about mental diseases by Dr Mark Hyman at www.brokenbrain.com where some 50 doctors explain various causes of brain diseases. It is an understatement to say that you will be shocked at the end of the docuseries. I strongly recommend watching it.
The trailer is overflowing with bait akin to "learn more after this commercial break!!" on the news. That technique generally correlates with nothing of substance coming later. Is the MH in your username for Mark Hyman?
Honestly, and this is just me, but services like Doctor on Demand or Teladoc have been incredibly valuable to me. Being able to schedule appointments for the weekend (or later at night) ensures it doesn't get in the way of work.
I was fortunate enough to get a pretty awesome doctor when I did it, but I seriously cannot recommend DoD enough.
First things first, talk to your regular medical doctor about medication. I could not fathom talking to someone without first having that, partially because it was so overwhelming.
Outside of this, it really just depends. Religious? Pick one that follows your religion. Not religious? Start with one connected to the local hospital. Have a gender preference with friends? Then choose that gender. I'd stick with folks with psychiatric degrees - a psychologist (therapist) or a psychiatrist. If you see a psychiatrist, not only can they prescribe medication if you need it, but they might hook you up with a therapist that can help you best. On the other hand, if you'd like to try to avoid medication, start with a psychologist or therapist. Licensed and educated, of course. This just helps you narrow choices, after which you can pretty much pick at random. The important part is just to make the appointment.
Tell them upfront you are uncomfortable talking to them. They should be easily able to deal with it. If you have a few sessions and still feel uncomfortable talking to them, you can try again using similar criteria.
If you have specific mental issues, like depression, you should look into psychedelic therapy. I’m not sure how many are legal, but would assume they are if affiliated with some study. Psychedelics can be curative w.r.t depression and anxiety, as long as you have the right guide/therapist.
Try at least six. Give each one two or three sessions to do something, whatever their thing is, and check if it helps at all.
Keep trying people until one really resonates with you and helps you.
Do not pre-judge methods. Go to "woo-woo" people as well as mainstream. Do not try drugs unless you have already tried at least ten or twelve non-drug folks. If you've been to twelve different therapists/healers and no one has been able to really make a dent in your issue(s) then that's a good indication that you have something more than "just" psychological and you should try drugs in a responsible manner. Again, don't be afraid to try several things under supervision of a responsible trained experienced professional. Don't be afraid to include cannabis if it's legally available in your area.
This comes from personal experience.
Last but not least, a lot of people in the modern space-age-a-go-go era are suffering from spiritual malaise. What are your deepest values, and are you living up to them in your daily life? In what or Whom do you have faith?
TLDR: One answer - if you're in a decent-sized city - is to look for people who have published on the particular issue you're having. My other piece of advice is : always set a time limit.
This is a difficult issue, for a few reasons. The stigma surrounding mental health means no-one (to a first order approximation) goes around raving about the really great therapist they found. This has a couple of consequences.
First, therapists don't specialise. They need to get clients, so they list themselves as being able to treat every mental health condition on the professional registers. Hence, look for people who publish.
Second, it's not hard for a mediocre-to-bad therapist to keep going and earn a living. There are no reputational consequences. Even the best therapists wont' succeed all the time, some people would recovered anyway, so it's easy for them to kid themselves that they are better than they are.
The other problem with mental health is that the incentives are backwards. Mental health professionals are paid by the hour, whether they help or not, and don't have any incentive to think about whether you would be better off trying someone else after all this time. And if you are depressed it's hard to get up the will to think about changing your therapist, so it's easy to let things drag on in the hope that they eventually work, wasting huge amounts of money and time. Hence, set a date at which, come what may, you will either stop or try a different one. Sooner than they want.
An easy filter is to reject any professional who does not hold a Ph.D. The costs are naturally higher, but, this worked well for me. That's not to say others are not qualified, but the signal-to-noise ratio seemed much higher to me.
No one should ever feel bad about seeking help. It's a great sign that you even want to seek help. Burnout is universal. I wrote about this recently:
"As I’ve gone through my 30s and 40s, I’ve been surprised at how many of my friends have suffered some kind of burnout. In fact, between the ages of 15 and 45, I would say that everyone I know personally has had at least one bad year. Back when I was in school, it seemed like some people were reliably happy, and other people were reliably depressed. And yes, many of those personality traits turned out to be consistent over several decades. But it was a surprise to realize that even the happiest people could fall into a dark spot. Some people are highly resilient, but no one is infinitely resilient."
"If you feel you need a therapist, the question then becomes, "How to find the right therapist?" If you are lucky enough to have the money or good insurance, I strongly recommend that you go to 3 or 4 different therapists, at least once, and see if you click with any of them. In some sense, there are no "generally good therapists" there is only the therapist who is good for you. One therapist might be great for someone else, but terrible for you. It's a very unique relationship, and it takes some work to find it. But if you lack the money or insurance that might provide you with the option to try several therapists, then another option, not quite as good but cheaper, is to go online and talk to others who suffer your particular version of burnout, and ask them if they would recommend someone in your area. Also, if your struggles overlap with the kinds of struggles that are addressed by any kind of 12 Step program, then going to the local chapter of that 12 Step program is almost always going to be your best bet."
Try an online Therapist first if that is easier for you. It goes via chat, instant messenger, or e-mail. From that you can move on to a face to face therapy later.
And also read books written by Yalom ;)
I remember I was so nervous and full of doubts about doing it, I had nobody I trusted I could talk to at the time but I was doing really bad. I first tried to find a familiar face on that directory, just based on pictures, someone I could see myself talking to. When I did find someone, it took me a few days before finally trying to reach them. It was extremely difficult to be honest. But I did it. It's been a few years now. Couldn't be happier with my decision.
Good luck. And feel free to ping me if you need any help.
You need to take a top-down approach. Have your GP rule out physical problems that can easily be identified objectively and cured before you delve into the subjective realm of mental health where there are no cures. Rule out hypothyroidism, diabetes, chronic fatigue, brain tumors, heavy metals, etc. before you entertain the idea that you have mental health problems. If you determine that you have a clean bill of physical health, find a clinical trial in your area(clinicaltrials.gov) where they're treating depression with psychedelics and get your GP to diagnose you with whatever that study requires for admission.
One of the best things I've ever done was to find a coffee shop to frequent. I've made many very very good friends there. One of them was a psychologist. Last year when I decided to get some therapy of my own, I asked her for a referral.
I will only ever purchase professional services through a referral.
That said, you want a therapist that matches how you want to see yourself as becoming. Mine is warm, friendly, and approachable, all things I'd like to be myself. I once had the idea that a more analytical approach might be more helpful, and so tried one out for a few sessions. Nothing worked, total waste of money.
Finding a good therapist is similar to find someone to date. Their qualifications should be good, but you need to find someone you mesh with personally. If you can't imagine hanging out with that person outside, you aren't going to have a good time, in my experience. You will likely have to try a few therapists before you find one you click with.
The way I've typically narrowed my options down is search for therapist either through insurance or through location (google maps).
Therapists often work in environments with other therapists, so I try to find those places, as they typically will have a variety of therapists to either ask about through the phone (giving your background information, what issues you are struggling with, what you are looking to resolve), or they will have a website that details each counselor's specializations and experience.
When you call one of these places, they typically have a helpful receptionist that will ask you background questions about yourself, and of whom you can ask questions towards about the practice, the practice's goals and philosophy, and the counselors that work there.
This process, I find, is the fastest and most comfortable (safest) way of finding a therapist. You don't want to hold off finding a counselor until the only options left are those 'no-choice' type options, because in my experience those places are bottom of the barrel in terms of how helpful they can be for someone that isn't dealing with issues that are truly tremendous issues to deal with.
I would advise taking one day to search through your insurance provider. Another possibly to print out a list of counselors within some radius of your location you are comfortable traveling to. Don't feel like you have to do all of this in one day.
Mark down which places 'sound' the best to you, whether it's a good location or the practice sounds professional. I understand how overwhelmed one can be with not having all the information you need to have to find a counselor before you have it, but following advice that sounds like common sense to you can be helpful. I know I have travel issues, so location and ease of travel has been a key thing for me in the past to find a counselor - I want to make sure I'm not going to get lost on the way there.
Once you have your choices narrowed down to about 5 or 10, start looking for websites for the locations individually. If the backgrounds of the counselors are listed, take note of the ones that make the most sense to you. Call those places, maybe only make one phone call a day or every other day.
Don't feel pressured into signing up for anything if it doesn't sound right to you. It's common when booking a first appointment to have to use a credit card, as many places will charge you if you cancel before some predefined amount of time (typically 24-48 hours).
Take it step by step. Just do a little at a time. If you feel overwhelmed, take a break, and come back to it when you feel ready to approach the next step.
I went through this search earlier in the year (been think about it for YEARS, best thing I ever did). Here's what my search looked like:
1. Asked for a recommendation from a GP (not my usual). Got emailed a big list of offices that I never called.
2. Wait three years.
3. Looked up therapists on my insurance provider's portal and psychologytoday.com. You can filter by zip code.
4. Blast out a copy-pasted message to dozens of therapists I found on those sites.
5. Got a few responses back.
6. Winnow out those who aren't actually nearby. Some therapists practice out of multiple locations, so their availability didn't always work.
7. Made an appointment.
8. I got lucky, the first guy I went to I felt comfortable with.
9. It's starting to help, things are getting better.
10. After a few sessions, he recommends I get evaluated by a psychiatrist. He's a therapist, and can't do "official" diagnosis/prescription.
11. Go back to step 3, but I also went to my actual GP and finally got a referral.
12. Got to psych appointment, get evaluated.
13. She sends me off to get some medical tests before prescribing.
14. New appointment for tests. Lucky, I can do them all at once!
15. I'm currently waiting on results.
16. Next step is follow up appointment with psych and hopefully a prescription. I'm going to continue to see my therapist since we have good report.
I know this looks like an impossibly involved process. Sometime weeks would go by between steps. I won't lie, it can be a dispiriting pain to go through. It's a sick irony that the very thing you're trying to get help with also keeps you from getting help.
We're programmers, we're used to breaking problems down into discrete, manageable steps. But when I did it here, it felt BIGGER and less manageable. such BS.
Once you get started, staying patient and hopeful is the hard part. I don't know your specifics, but here's what worked for me to get through:
* I started really paying attention to my mind and body.
* On the mind front, that was mostly giving myself time to think and just be in whatever I was feeling, good or bad. I'd gotten into the habit of always having a podcast on, and that meant I stopped really processing my thoughts. Now, I'm trying (emphasis on trying) to see menial tasks as a thing to do in and of themselves (cooking, cleaning, driving). That gives my mind unstructured time to breathe. If I listen to a podcast, that's and INTENTIONAL activity, where I want to listen, rather than want a distraction.
* On the body front, that meant making an effort to feel like I'm taking care of myself. Shave regularly instead of always having an almost-beard, starting a skin care routine for my face (I tried these snail goo eye patches that are cool, plus you can just throw them on and watch tv but you're still "doing" something). Brushing my teeth everyday. (I work from home, so hygiene is the first to go when you're feeling the way I felt/feel).
* Some people recommend a journal, but I always just felt guilty for not keeping up on it. If you do this, START SMALL! NO BULLET JOURNALS! you will get overwhelmed.
Some of this may help, much of my advice is specific to me. The important thing it to pick something small and try (TRY, you won't do 100% of the time) to do it. Then, build on it once you fell like you've got a habit, where it doesn't feel like a chore.
Most shrinks I've had experience with act like pez-dispensers for your typical SSRIs and benzos. They listen for half an hour and then change the dosage a bit. I would do a psychological evaluation and look for someone with experience in CBT.
This is a tough problem! Writing this to address your concerns but also for the comment readers. I don't provide great solutions, but I think validating your problems is helpful and hope there's something useful in here:
I've been thinking for a while now that we need people you go to help you find a proper therapist. Like a consultant/dispatcher/human load-balancer/Mental Health GP. Medical GP's have no idea what they're talking about in this department (save some outliers) and would probably admit to that if pressed.
The approaches as they stand now aren't ideal, so I feel your frustration:
1) Pick one that accepts your insurance located near you: Those lists that the insurance companies publish aren't up to date and Psychology Today is also dicey. And you're right, they all start to look the same (they are most definitely NOT in reality). Many mislead by saying they accept insurance but really mean out-of-network benefits, which typically aren't great especially if you're not working for a mega-corp. There's also a sizable body of therapists who will charge high rates (not in proportion to quality) because some rich clients won't care. It's a bit dirty to me, but a lot of the time they'll reduce their rate very quickly and dramatically once they know you're not rolling in hereditary wealth. For example, I've seen $350/hr off the bat reduced to $100/hr with one simple statement of "that's outside my budget".
2) Pick by approach: In theory is a good way to start, because some modalities probably aren't a good fit for certain classes of problems and personalities. However, it's a tough balancing act. A therapist who is too focused on one modality is probably a bit inexperienced, because they're in everything needs a hammer mode. However, listing too many modalities sometimes indicates a lack of rigor, focus, point of view.
3) Sites like Therapick are great in theory in that you get a video introduction to assess someone who might be a good fit. However, they tend to attract less experienced therapists (who could be good!) who are trying to build up their client-base. Just like rent-stabilized apartments in New York City, you're less likely to see the most experienced and popular therapists doing active recruitment like this because they're snatched up quickly and don't need to spend the time and effort.
4) I would highly discourage any of those phone/texting therapy services. Who knows, they may work for some, but they don't strike me as plausible solutions for most, if not all, people. If it's money that's a concern you're trying to solve for (which it usually is to some degree), there are other approaches to solving that. If time and convenience is a concern, you really need to get reevaluate what you think therapy is. To me, these services are bandaids, which I suppose have their utility.
5) Recommendation through another therapist: This can work, but you should be aware that therapists form milieus — talented ones tend to hang out and consult with talented ones, and vice versa. So if you have a bad therapist, it's likely their reference is as well. My personal, albeit possibly offensive, theory is that there's small pool of truly gifted therapists (less than 20%). I subscribe less to the notion that there's a perfect match therapist for everyone and that it's just a matter or style and personality.
On top of all this is what I called the Fundamental Therapy Problem in that it's quite possible you shouldn't be the one deciding what style would be best for your long-term interests. Don't think too hard about this one, because it'll drive you nuts :) But it helps to try to assess based on gut feelings of feeling secure and feeling challenged, rather than a heady, logical assessment.
At the end of the day, it's common knowledge (and backed by some studies) that it's really about the relationship between the people. If you feel intimidated, baffled, weirded out, or annoyed consistently — or if you don't truly respect your therapist — it simply won't work. Don't waste your time hoping to get used to it, it won't get better.
In your situation, I'd recommend a strategy of finding a good-enough therapist to start. But there'll be a point where it'd really help to find an excellent one. That will be easier once you've leveled out a bit.
In conclusion, references are the best from friends you trust (hard to get sometimes because of privacy concerns), and then a scattershot (guess and check) approach. Expect it to be a bit of an expenditure when you're interviewing around at the beginning. But have faith, things can get better rather quickly once you have a decent therapist situation established.
I had to find a therapist for someone I know who was unable to do it for themselves. It's difficult; even referrals are hard because, as one therapist explained to me, therapists don't ever see each other practicing their craft and what they do is confidential.
A quick answer: First, expect to shop around; odds are against the first one being a good fit, but be patient - a good fit is out there. Ask the HR departments at your employer or at large companies; tell them your difficulty in finding a therapist and I'd expect they would be happy to help - it's free and easy for them. Their referrals may charge high rates but hopefully they've been vetted by the feedback of numerous employees (though of course those therapists might also serve HR priorities - HR may prefer one visit for medications to a year of talk therapy).
I looked into it, doing research and talking to numerous therapists. Here's what I understand:
* It's the singer not the song. A widely accepted belief (I don't know how widely, but more than one professional confirmed it and I've seen research) is that success depends much more on the therapist than on their technique. Also, good therapists have a variety of tools that they adapt to you. IMHO if they are selling their technique ('as seen in my seminar / published in my book!'), that's a bad sign.
* Rapport between you and the therapist is most important. If it's not there, move on. You need to feel comfortable and trust them enough that you can be completely open, even about the things you don't admit to yourself, and to not feel threatened when they say things that hit a nerve.
* Characteristics of a good therapist (leading to good rapport): 1) Empathy, 2) Positive regard (toward you), and 3) Congruence (the therapist's congruence with their own emotions)
* Characteristics of a successful patient: 1) Feel safe with the therapist; 2) Trust the therapist; 3) Ready for real change.
* Find someone with experience treating your problems. As you don't have a diagnosis, that can be tricky, but a trial session with a few therapists can give you direction.
Finally, I found this to be very helpful and showed it to a professional who said it was valid:
I am a psychotherapist as well as a developer, I'll share some of the things we mental health professionals think or suggest. Some of them have already been said here, but I thought summarising my own thoughts on the subject might help.
1) There is no magic formula. Most schools of therapy believe a sincere relationship between patient and therapist has to develop for it it work great. Therapist casting is a great suggestion, and as someone else said, if the therapist isn't comfortable with that, maybe he isn't the right fit.
2) I have studied and trained in different schools of therapy, mostly because I noticed quickly, how certain schools work better for some patients as well as for some therapists. Many times we are limited to what we are introduced to in school, masters or therapy school. It's like working with different programming paradigms, some people view of the world or way of thinking work better for some paradigms that others. We can all adapt, and learn how to work in a particular frame of mind.
Certain people fit better into a therapy style/school/paradigm. Certain pathologies, illnesses, problems get better results with certain techniques.
I would recommend, also asking the therapists what school / type of therapy they work with, and how would they approach your case.
The first thing I always do before recommending a therapist is get to to know the person asking a little better, then about their problem and expectations.
This helps to shrink the list of possible therapists.
3) Ask the therapists if they supervise their cases and if they have gone to therapy themselves.
This is vital. The good therapists know our mind and emotions are our tools of the trade. We have to able to differentiate if what we are feeling/thinking in therapy is a miss interpretation we might be having because of our own issues, or if it is a correct interpretation of what is happening to our patient.
The only way to achieve this, is with our own therapy and continuous supervision. Therapy allows us to work on our own issues, be aware of them and recognise them when they pop up.
Supervision allows us to have other experts help in noticing our blind spots when working with each case.
A therapist that doesn't supervise, will get stuck in some therapy patterns and have a harder time noticing your particularities.
A therapist that hasn't been to therapy, might be to blind to many things, feels above their patients and won't really connect with you.
Most good therapists I know have been to at least 2 different therapy processes along the years (lasting several years each).
4) We always recommend the therapist as a person. I don't just recommend people from a technical/training perspective, I recommend the person, because in the end, a therapists - patient relationship is that, a relationship between two people. The therapist values, perspective on life, and life experience, will pour into the therapy, no matter how much supervision and therapy we get.
You've managed the first step, which is coming to the awareness that you're dealing with something and need some professional help.
I won't claim this to be a recommended way, it's only what has worked for me. I first sought therapy through the system (well, the NHS because I was in the UK...'the system' sounds ominous), but grew to feel that they weren't equipped to address my particular needs. It was useful but professionals working within these institutions often lack the flexibility to explore alternative processes.
Since that time (around 9 years ago) I switched to seeking recommendations for local psychotherapists; professionals who were qualified to work on the level of meditation, somatic healing, and other things you're not likely to get from a GP appointed therapist or counsellor. Most cities will have directories for such therapists and, as is normal, you'll get the chance to have an initial consultation call to understand whether that's actually the right approach for you. A responsible practitioner will say no if they don't think it will work, and may well offer recommendations for something more suitable.
It might be that you do a few sessions and realise that you need to touch on something else, and maybe you need someone else for it. Or you don't feel a rapport so you're not making progress. This is all fine, it's important that you allow for some trial and error so that you can establish a relationship that supports you and works for you.
The most important thing is to use this initial spurt of courage to reach out to someone and get the ball rolling, even if you don't commit to them. It's so easy to overthink it and take a perfectionist approach, where you have to intuitively know that you either need a life coach or a psychiatrist or someone else, and eventually the inertia will itself become a blockage and a contributor to your burning out. It is overwhelming, I know, because you don't know who you can trust.
On that level, what I would suggest is to reflect on your circumstances. A therapist (of any kind) is going to be with you to explore your past and work through issues there. A life coach is going to be with you to explore your future.
After all of that, if you have a close friend or a partner you can trust implicitly, try reaching out to them by asking if they'll hear you out. The idea here isn't to let them shoulder your burden, it will just push them away. Instead, it's to know that you've got someone who wants to be there for you, and is happy for you to open up to them, while allowing yourself to reciprocate should they need a confidante in you. This can work wonders while also using therapy to work through what you're going through.
I don't know how any of this applies to going through insurance, and it doesn't offer any concrete answers, but unfortunately we're not dealing with taking a broken leg to the nearest hospital.
And to re-iterate some other points: don't commit yourself to the idea that therapy will 'fix' you or you'll get some immediate result. It might be that you need something else and you're not quite aware of it yet. To that extent, I wouldn't recommend jumping onto the spiritual path with meditation and all of that unless you feel your own calling to it and are confident in yourself about what you're opening up to. There are plenty of snake-oil salesmen out there who will take advantage of your current vulnerability and try to rope you into something that will do a great deal of damage over time.
I would take a road trip to Denver just to get stoned. Think about it. Change of scenery. For the $100/hr + driving and hassle you'll be spending on pychotherapy with odds are the wrong therapist + meds, seems like a premium room and mj tour of Denver is cheap and effective. Seattle probably sucks though.
Be careful, try to figure it out yourself first. There was a disturbing experiment called Rosenhan experiment. Research Cognitive Behavior Therapy and try a good faith effort and commitment to review all of the material and exercises, if you can, before seeing an "expert"
In the Rosenhan experiment, the subjects faked the symptoms of psychosis until they were involuntarily committed. If you fake symptoms for an illness you can't be surprised that doctors assume you have that illness.
This is a far cry away from seeking a professional's opinion in good faith. Telling people to avoid help citing Rosenhan is extremely irresponsible.
unfortunately it wasn't that trivial. A second follow up experiment ruled the "faked symptoms" variable out, in my opinion truly exposing that the entire profession is subjective and not based on scientific fact finding evidence.
I suggest you don't. Went through that route by going through several mental health specialists and doctors. I have also seen others close to me go that route too.
My advice: Avoid that route like a plague.
The short story is: Their incentive is the complete opposite of yours. They make money from your misery, and continued depression. They are not incentivized to make you better as that will mean less money for them.
Lots of psychiatrists make money from big pharma sponsoring. Their job is to prescribe as many medicines as possible. It is a hell-circle then. The meds keep you in a "cool" state but not productive/social. After a while your consciousness start to realize how bad your situation actually is. The doctors remedy to that is to give you more medicines and stronger doses.
How I did it? You are the best person to cure yourself. Once you are very close to suicide, you realize that nothing matters. So be courageous to make life changing decisions. It'd help if you have the cash to finance such decisions.
Good luck. If you are done and in doubt, take a plane ticket to a 15h far country.
I feel that there is some truth in your comment, but that the conclusion is completely wrong.
You're right that there are some incentives for therapists (or "fake therapists") not to help you, or at least not to help you enough. In fact, there's a big market of scams in this area. But a big part of the market is not there to scam you, either because of morals / good faith, or because of counterincentives (rating systems, social proof, building trust with the patients, recommendations, competition, etc.). You could also argue that many other businesses such as language schools have incentives to keep you around forever, and certainly many lengthen the process, but the system mostly works.
Almost the same can be said from psychiatrists: They certainly have some incentives for keeping you around forever or scamming you, but they also have the same counter-incentives. For example, psych meds are also widely prescribed in countries where healthcare is not as much money-based as in the US.
And additionally, there's ample easily-accessible scientific literature on antidepressants online done by both sponsored and non-sponsored scientists. SSRIs suck, and for a lot of people they do nothing useful or are even counterproductive, but there's actually nothing that is qualitatively better than SSRIs for most depressed/anxious people.
Finally, recommending inaction until you reach rock bottom (where there will supposedly be a surge in motivation that will make you fix your life) is very reckless advice. First, because at rock bottom a lot of people will be more motivated to suicide rather than take productive steps. Second, because many people will not actually reach rock bottom, but rather stay in sustainable misery indefinitely. Third, because while depression/anxiety have many environmental factors, they are not solely environmental, so for a lot of people even completely replacing the environment will not help much. Case in point: I went from living with my parents, to living on my own on a city 1h away and earning a living by myself. It certainly helped with life skills and confidence, but the core mental problem was still here.
If you want to feel more depressed - go to a psychologist. If you want to get a mental disorder - go see a Psychiatrist. If you think you need to see one of those you are not sick enough. Instead you want to go to a executive coach, or someone who practices positive psychology. But if you are talking to aliens on a daily bases, or think it's perfectly normal to wash your hands ten times in a row, then go see a therapist.
When you get into a mental hospital, the first thing they do is to fix your daily routines. So if you are feeling mentally ill, fix your daily routines! Wake up at the same time, go to work the same time, and very importantly - go home from work the same time, eat the same time, and go to bed the same time ever day. I have never felt this good since I got my routines fixed. I long to get to work every day I wake up. And I have my wife to thank for a lot of it, if I'm five minutes late from work it feels like she'll kill me. I used to work 12 hour days and sometimes whole nights before I met her. But I'm more productive now ! I can no longer finish a project over a weekend (with no sleep), but I get consistent progress every day several months in a row.
I’m a once computer science graduate now Licensed Clinical Social Worker in private practice. For what it’s worth, I think finding someone you click with is more than just an intuition or the luck of the draw. In clinical speak the “match” you have with a provider is called the therapeutic relationship and it’s inportant. In studies about the common factors across the board that are correlated with successful clinical outcomes the therapeutic relationship is more strongly correlated than even the therapeutic modality being used (psychodynamic or CBT as examples). So finding someone that speaks your language is important to having good rapport. But obviously scheduling that first appointment is critical. I like to make that process smooth by responding to email or voicemail inquiries within 48 hours if possible. Also the first 30 mins consultation either over phone or in person is free of charge to give the client a feel for what it would be like working with me no strings attached. I structure this as 15 mins to explain what’s going on, history and questions I have to also determine whether I am in fact a good fit for them given my own training and experience. The last 15 are for my impressions and reflections and some of my past experience to support that. Afterwards if someone feels that they’d like to continue we make this a first appointment by reviewing disclosure forms, agreeing to the terms of therapy expectations, confidentially, etcetera and then go another 45 minutes to make it a meaningful and complete meeting. Hope explaining some of my process at the onset of taking on new clients is helpful to folks in tech looking for support. In fact this is part of who I think I work well with. I’m in a major tech booming city on the west coast, for folks wanting to ask more questions, pm me.