"How do I find the right therapist?" I am often asked this question and would like to preface my opinions by saying that they are just that – opinions. Therapists are as diverse as their clientele and I presume that all would have something to add to this discussion, or perhaps an entirely opposite perspective. If you are looking for a healing, caring, supportive, and emotionally challenging experience, this is my take.
1. All therapists are different, but I would say that the primary characteristic of importance in your therapist is that he or she tries to make you feel comfortable and wants to be present with you.
2. Having said that, everyone will be nervous at the beginning of therapy, your therapist included if he or she is human, so give yourself a few weeks to settle in. If you feel inclined, talk to your therapist about feeling nervous and he or she should response empathically.
3. Therapy can be funny and light-hearted at times, but you should not feel the need to impress or entertain your therapist.
4. Therapy can be humorous, intellectual, and emotional, but remember that intellectualism and humor can be used to defend against difficult emotions. Therapists are in the business of emotions, so you may be challenged to access your own at times.
5. You should feel safe in therapy at all times and your therapist should be able to create that safety with you.
Many of the clients I see have discussed "settling" with their previous therapist(s). He or she would listen most of the time, or was good enough is not an ideal therapeutic situation. You have the right to the right fit for you. If it isn't ideal, talk to your therapist about what is missing. If he or she responds in a way that upsets you, say that you're upset. If it gets to the point where you want to end the relationship because of this disconnect, talk about it. A relationship with a therapist should enhance your ability to have relationships in the real world. As a model of relationship, a therapist should encourage honesty, even when it is difficult, and should always have your interest first on the list of importance.
Step 1. Assess your needs.
What do you need and what do you want? You can have both needs and wants met in therapy with the right person. Read the following questions for guidance on your needs and wishes for therapy.
Are you going through a life transition like college, marriage, divorce, parenthood, or late adulthood?
Are you a member of an oppressed group? Is it important to you that your therapist is a part of this group or has special training around your difference?
Will it be difficult for you to speak to a stranger for the first time?
Have you had therapy experiences in the past that did NOT work? What was missing?
Are you depressed, anxious, sad, or do you have a dominating emotion that comes to mind?
Have you consulted a medical professional and if so, what does he or she recommend?
Do you just want to talk and have someone listen?
Do you want to explore your past or focus on the present? Or both?
Do you want to be challenged or supported unconditionally?
Do you want to talk about goals and be accountable to your therapist in attaining them?
Do you seek structure or freedom in therapy?
Are you more comfortable with a particular gender, and why? Would it be helpful to you to have a therapist representing the gender of comfort or perhaps to have a new experience with the gender you do not prefer?
Are you comfortable with a particular age group, and why? How would your experience be enhanced or compromised with different age groups?
What are you able to pay for therapy?
Step 2. Find a recommended therapist
Word of mouth is the most helpful way of finding a clinician but more and more, therapists are advertising and promoting themselves online. There are some websites that verify the credentials of the therapists who are advertising (psychologytoday.com, goodtherapy.org) so make sure that the therapists you read about have credentials.
Money is usually an uncomfortable topic for most people, but prospective therapists should be clear about charges when asked. Some therapists work on a “sliding scale” basis, meaning that they have different rates depending on financial need. If you are in need of financial assistance, think about what you are able to pay and ask the therapist if the rate would be acceptable.
LPC-i and LPC – These therapists are master’s level professional counselors who are seeking or have obtained a clinical licensure. You can expect to pay more to see an LPC than an LPC-Intern.
LMSW and LCSW – These therapists are master’s level social workers who are seeking or have obtained a clinical licensure. You can expect to pay more to see an LCSW than an LMSW.
Psy.D. or PhD. - Psychologists are doctorate level clinicians who perform therapy and also focus on psychological assessment or testing. Psy.D. is a newer degree plan focusing on clinical psychotherapy as well as research and testing. You can expect to pay more for a doctorate level clinician than an LPC or an LCSW.
M.D. or D.O. - Psychiatrists are medical doctors who are primarily focused on psychobiological assessment and medication management for patients. Some psychiatrists are trained in psychotherapeutic techniques but most have little training in psychotherapy. You can expect to pay the most for a psychiatrist since he or she has a medical license and can prescribe medication.
Unfortunately, when assessing therapists one can rarely tell which will be a fit on paper. You may be able to read a bio on the therapist that may help you get a feel for his or her personality and theoretical leanings, but having a conversation is the best way to assess goodness of fit.
Use the questions from Step 1 to guide you in expressing your needs and ask about their training, specialties, and areas of practice. Despite the traditional hierarchy, you may find your needs anywhere in this ranking of therapists.
Step 3: Get to know the therapist
In order to assess fit, one has to “talk the talk” in some ways to understand how a therapist operates. Read up on types of therapies and you may find that one resonates with you.
Psych Central's article on Psychotherapy - check out the types of therapy on the left index
Ask questions and expect to get your needs met! This principle is basic to living a life with healthy self-esteem and self-care.
As always, take care.
Depression and anxiety go hand in hand. At times they are confusing bedfellows, but it is nearly impossible to have one without the other. For example, a woman says, "I feel depressed and can't get out of bed. Then my husband comes home and I just want to bite his head off. I'm such an awful person." This person isn't awful, she's suffering from a complex combination of anxiety and depression. Her anxiety may be manifesting as lashing out (or acting out behaviors) and one of depression's lesser known side effects is irritability, which can lead to such thoughts and behaviors.
The obvious definition of depression is "a depressed mood for most of the day and a diminished interest or pleasure in activities" in the words of the Diagnostic and Statistical Manual-IV-TR (DSM). Another tricky depression antic is that it can be symptomatic in the form of low self-esteem or low self-image. You may hear someone saying things like "there's no excuse for the way I've messed up my life," or "it's my fault that I didn't go to work because I'm lazy." The DSM also points out "excessive and inappropriate guilt" as a symptom. This might manifest in an "I can't get over it" attitude or an "I'm totally unworthy of anything fun or good" campaign.
Other signs may be excessive crying, severe change in appetite, sleeping all the time or not sleeping at all, feelings of worthlessness, indecisiveness, lack of concentration, recurring thoughts or images of death, and at it's worst, ideas of suicide.
Anxiety can take on many forms like panic attacks, fears about being in public or socializing, and reactions to traumatic events, but in terms of depression, general anxiety can also be the perfect compliment to its counterpart, depression. Anxiety often produces excess chemicals in the brain that leave us feeling on edge, in hyper drive, overwhelmed, fatigued, unable to concentrate, irritable, tense, and not sleeping like we should.
It is important to understand the interaction of depression and anxiety on the mind and body to understand how to treat it. When a person is in a state of arousal (anxiety), the body and the brain work hard to calm the system, but over time those biological functions become overworked and no longer soothe our anxiety. We have to learn how to "override the system" in order to control our anxiety - namely, taking long deep breaths (in the nose, from the belly, and out the mouth), and changing our thought patterns when we become anxious or depressed.
Next time you think, "I'm such an idiot," and you can feel yourself turning red, feeling keyed up, or your heart beating quickly, stop and take 5 deep breaths while telling yourself something realistic about the problem. "I'm only human, and humans make mistakes." "This won't matter in one week's time." "I'm very smart, I just rushed and made a mistake that I can fix." Or, try to externalize the anxiety: "Anxiety is attempting to intrude on my mind and body right now, but it will not overtake me. I know how to breathe through this."
If you are feeling depressed, my best advice to you is to be kind to yourself and seek help. If you can lie in bed for an extra hour, and you feel like you need to, then do it. If you want to comfort yourself in some way to not feel so badly and it won't hurt you in the long run, I encourage it. We are taught to be so hard on ourselves and it is very important to fight the urge to push yourself to your limit all the time. Loved ones are the best antidote to depression, even though it may seem scary or impossible to share what you are going through. If you sincerely and repeatedly reach out to loved ones and still feel alone, seek help online, find a local support group, or get in touch with an organization who helps people in your situation. It is important that you feel understood and connected when experiencing depression and anxiety.
If your depression is to the point of suicidal thoughts or urges or thoughts of harming anyone, you should immediately seek help from a professional! Better yet, seek help from a professional before your symptoms are life-interfering. You do not have to wait until you are incapacitated to ask for help.
A fascinating discussion among physicians on the efficacy of antidepressant drugs - to take or not to take medication for depression. Watch the 60-minutes piece and read Dr. Amos's response. http://jajsamos.wordpress.com/2012/03/05/black-and-white-thinking-in-living-color-the-placebo-antidepressant-controversy/
I'm flattered and delighted to be nominated for the Versatile Blogger Award by Dr. Jim Amos! I would like to sincerely thank Dr. Amos for putting incredible thought into his posts and working so hard to keep people informed about psychiatric issues. Dr. Amos is a true pioneer in bridging the gap between mental health professionals and the general public. If you have not already seen his blog, check it out at The Practical Psychosomaticist: James Amos, M.D.
In accepting this award, I am obligated to:
- Thank the Award giver and link back to them in my blog post
- Share seven things about myself
- Pass this award along to recently discovered blogs I enjoy reading
- Contact my chosen bloggers to let them know about the award and post the award picture
Bloggers I admire, and why:
I Choose Change - an amazing look at the power of change
Everyone Needs Therapy - for fighting the stigma of therapy
ProjectATTEMPTERS - for bravely shining light issues of suicidality in society
The Soulful Contrarian - for fearless authenticity
Transitionelle - for bravely seeking joy and challenging herself
BlissfulMindWellness - for offering practical ways to be mindful
7 Things About Myself:
- I have a weakness for chocolate.
- I am married to, in my opinion, the greatest man in the world.
- I love living in Austin, Texas and it is my favorite city in the U.S.
- I have never lived in a place where it snows.
- I love flavored coffee with lots of sweetener and coffeemate.
- I am an advocate and ally for social justice causes.
- I believe that people are inherently good and deserving of respect.
Thanks, again for this honor, Dr. Amos. Take care all.