Ask HN: How to find a mental health professional?

It's easier to talk yourself out of skipping an appointment when the trip there isn't intimidating on its own.

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.

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.

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.

It may take you awhile until you find the right one but it's absolutely worth the time.

Stay strong.

You can use the search tool without being a member or qualifying for the reduced rate sessions. Really useful for those in the U.S.

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.

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.

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'm sure similar services exist in other cities.

https://therapyreferral.org/

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.

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.

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.

EDIT: This interview between Ezra Klein and Johann Hari is about modern depression, and I heard it at the exact right time: https://art19.com/shows/the-ezra-klein-show/episodes/805c9dc...

I don't know what the professional registration requirements are, but you probably want to find someone with a registration, and who has public liability insurance.

After that you'll want someone offering an evidence based therapy. CBT has good evidence, but there are others.

Then it's just who you get on with. You'll spend about an hour a week, for about 10 weeks, with this person, so you want to be able to talk to them and feel that they understand you.

If you can cope with self guided from a book you can get Mind Over Mood. This is sometimes used in some English NHS settings.

https://www.amazon.com/Mind-Over-Mood-Second-Changing/dp/146...

If you can cope with self guided from a computer you can try Mood Gym, a well respected Australian website.

https://www.moodgym.com.au/

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.

4) Be patient. It’s going to take time and work.

Good luck!

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.

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.

BTW, exercise helps a lot :)

It's one of the more frustrating bits of the getting better process.