Ask yourself what TYPE of therapist you want:
- the type that give you a prescription drug to suppress the symptoms that you complain about, or
- the type that knows how to search for the root cause of the health issues and informs you how to get rid of them.
In the US, "therapist" generally means a licensed counselor (master's level education), marriage and family therapist (also master's level), or psychologist (doctorate). None of those practitioners has the authority to prescribe in most US states. (A few states allow psychologists limited prescribing rights.) There is no type of therapist that will give you a prescription drug to suppress symptoms, especially without also providing talk therapy, which is the job they trained to do.
That's very true. Sometimes the work only comes once you start to get better (and then don't think you need the help). This advice could work if someone has noticed a loved one needs help and has to seek out help on another's behalf. It took me years to finally reach the step of starting the search which was super hard. I'm getting good results though.
My wife has called over 10 therapists in the last few months. All of them have had no openings for new patients unless you agree to see them off the insurance. The rejection from so many therapists is taking it's toll. It's even more depressing to get up the motivation to research a new batch of therapists, get up the nerve to call, only to be rejected again. The act of finding a therapist is more depressing than just having depression.
That is technically insurance fraud. As a provider, when you accept insurance from a specific company you sign a contract that says you are required to accept that insurance as payment if you see a client who is a customer of that insurance company. You cannot hold specific "insurance" and "cash pay" slots. A large practice in Boston is being investigated for this right now, and it might put them out of business.
Is it fraud to have cash pay slots that require you not have insurance? From your description it sounds like it isn't.
They might (They do, this has happened to me, and the end result was not getting care I needed, but anyway) suggest you not inform them of your insurance, then it's your fraud, not theirs.
As a provider, if you do this you're putting yourself at massive risk. A patient could at any point (maybe you annoyed them that day) decide to request reimbursement from their insurance for your past sessions with them. That would probably trigger an audit, and could get you kicked off the insurance panel — and worse, be on the hook to pay back the insurance company for every cash payment you took that should have been covered.
I don't know your location, but call local colleges that offers a degree program for an MFCC license.
The student are in their last year of training. The conversations are recorded, and listened to by a licensed therapist.
I found the $350 hr. "Doctor" to be just as effective as the $15 hr. student therapist. (The sessions are 50 minutes)
In all honestly, I didn't find therapy helpful, but you need to go through it in order to realize yourself if it has any value.
Oh yea, in order to see most Psychiatrists, they want you to see a MFCC first.
Then they usually put you on a drug that takes six weeks to work. They never worked on myself. I must have tried 10 different tricyclics/heterocyclic anti-depressants. Nothing helped. I'm now on two very addictive medications, and trying to taper off them. I just have a feeling my Psychiatrist is getting ready to retire.
I'll apologies in advance to the Psychology students. I know the profession means well.
You sound like a caring husband. That's Huge. Having an emphatic person in your life is so important.
In my case, my problem was debilitating anxiety, and when my life fell apart because I went from the most capable guy in a room to a trembling mess. That's when the depression hit. When the depression hit, I was kinda relieved, but it just stayed there.
I ended up seeing a a few Psychistrists. It's so much of an art, even though they had so much science in school. And yes--most medicine relies on placebo too. I know.
That sounds horrible. It gets to one of the main problems with finding a therapist where you do some research and find someone that you think you will connect with, then reach out and risk rejection because they are full or don't have availability when you need it. Even if they offer you a referral it isn't the person who you were excited (on some level) about.
My wife is a therapist and tries to prevent this by being as transparent as possible. She posts her rates, her calendar, and makes it very clear that she is private pay only on her website. By the time someone reaches out to her, they usually know that it is going to work because they have had the opportunity to see all of that information.
A couple of other suggestions from someone who has had a long journey on the SS Mental Health:
- Gender. Consider what gender you might be more comfortable with. Many of my male friends prefered female therapists, I personally felt like I was talking to a maternal figure and found I was better off with a guy. No shame in either choice.
- Trial period/multiple options. When I first moved to my current city I made appointments with multiple therapists, even seeing two simultaneously for a few weeks. You want to be comfortable with them and it can be very hard to tell from one session. This is obviously very insurance dependant though.
Agree with both of those. The gender thing in particular I went back and forth with a few times until I settled on what made the most sense for me. I think it's something most people will want to think about.
The other thing I'd include is that it's helpful to realize you're not trying to find a best friend. You're looking for a therapist, and how they can help you is a lot different from other relationships you might have had with people in the past. Once I realized that, it made it easier for me to adjust and find someone that fit me best, rather than someone I had to like, or enjoy my time with, or other "normal" benchmarks you tend to look for otherwise.
Another suggestion: age. It's usually wrong to discriminate on age but when it comes to therapy there's broad agreement that people with more life experience (and likely more time practicing) are often better placed to offer help. Let others be the guinea pigs of that young and promising therapist and choose for yourself someone with a few decades of experience.
> there's broad agreement that people with more life experience are often better placed to offer help.
Broad agreement among whom? As with MDs, I would expect several complex trade-offs. Particularly between the value of medical (and life) experience against the value of being trained with the current science and treatment methods. For therapists I would also expect more significant trade-offs due to the difficulty of building strong therapeutic relationships across large age differences for some patients. Are you aware of any studies on the issue?
Can you link to published research indicating that there is any correlation between therapist age and patient outcomes? Many people come to the helping professions later in life, and time spent practicing is the just about the only factor that counts for behavioural therapies (with the caveat that therapy outcomes are a difficult thing to measure). [1][2]:
1: Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care - Wampold, Bruce E.,Brown, George S. (Jeb)
Journal of Consulting and Clinical Psychology, Vol 73(5), Oct 2005, 914-923
2: Huppert, J. D., Bufka, L. F., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2001). Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder. Journal of Consulting and Clinical Psychology, 69(5), 747-755.
> time spent practicing is the just about the only factor that counts for behavioural therapies
When using age as the predictor I'd imagine time spent practicing is the latent metric actually being measured. You can't have 10 years of experience at age 25. That said it seems silly to use age when time spent practicing is a readily observable value.
If, as GP stated, life experience was a significant factor in fostering the therapeutic relationship than older therapists with equal or lesser experience than their younger peers would have better results, though I agree that it likely is simply a proxy for YoE
Anecdotal, but imho old therapists practice older research. Younger ones are more apt to continue their learning, with the exception of my mother, who is nearing her 80's, still has a vibrant private practice, just completed a 3 year academic program (well past medical school she did in her 30's) to maintain current training, etc.
Its a mixed bag on age. Younger, I think, is better due to both learning more recent research and also continuous education. Relatableness is a factor. Again, all anecdotal.
If you're in the NYC area, I know a bunch of folks who have had a really positive experience with http://www.kenwoodpsych.com/ - it's a practice that helps match you to a therapist that matches your needs, communication style, and financial/location constraints.
Go to http://www.brokenbrain.com to understand the root causes of mental diseases. On this website you can also find the solutions (relatively easy once you know the root cause).
After visiting this site you most likely understand that you want a doctor that finds the root causes that hurt you.
Note that a person that tries various drugs to see if they have some effect on you is not a person that finds root causes.
I've seen more therapists in my lifetime than I care to admit. But something like this would have helped a lot when I was starting out.
The casual approach does a really nice job at breaking things down and explaining parts of the process, without feeling like it's being dumbed down at all. It makes it feel very approachable, which is very welcome, given how daunting it felt (at least for me) starting out.
I cracked up at "My therapist is dull and doesn’t laugh at my cat memes. Should I keep seeing them for therapy?".
I’ve been in and out too. The biggest problem is cost, because in-network doesn’t provide you with enough sessions (insurance limits the number of sessions), you’re stuck having to pay out of network costs if you want more than once a month or once a week. I was looking at an extra 4 times a week, but therapists were quoting me $250 per 50 min session.
That’s $1000 per week, I cant afford that and I’m confident in my extreme thoughts getting worse and there’s nobody I can talk to about extreme vengeful hurtful thoughts and once a month or even once a week isn’t going to help when I’m genuinely asking for 4 sessions a week but insurance will never cover that so I’m stuck having to pay out of pocket and as I said this once a week is just not enough and so I’m stuck with my thoughts where only every now and then I can make a rational thought and the rest of the day is filled with unimaginable extreme pain and extreme thoughts.
And worse, therapists won’t reduce their price from $250 per session hour for these extra 4 sessions per week that I’m requesting, because, obviously $1000 per week (for 4 sessions) is a lot of money for them. This industry turns into a sham when therapists can charge $1000 per week to the man scraping by (but looks healthy enough to give the impression he can afford that amount)
That is a great document. Really covers all kinds of stuff in just the right amount of detail.
Pedantic alert: I know it isn't you, but your wife... but MFT degrees don't "specifically on couples and family therapy." The degree is just named that because the license is named that. The programs cover individual, couples, and family therapy but since the license isn't named that the programs aren't named that.
Doctor rating sites are crap because people are far more likely to emotionally sway hard positive/negative to doctor exp than something like restaurants. I find doctors by word of mouth and visit then once, and grade them HARD on my first experience, including their practice/admin/location etc. I think people trust their own experiences over others' in rating something as personal as a doctor (or therapist)
I always find it strange that going to a therapist is something relatively normal in the US. I don't think I have known anyone who has openly talked about going to a therapist in this part of the world (UK / Spain).
Does the US culture there produce more stress and broken people, or us Europeans just more ashamed of admitting to this sort of thing or is it something else?
I can't speak for Europeans, but in the US it greatly depends on the person. There are many who are open about seeking help, and many who would never go to a therapist.
Talking about problems and issues with someone is important. If it's not friends, or a community leader (priest/rabbi, etc), a therapist is a great option.
Do Europeans talk about their problems with their friends more openly? Perhaps this is the cause of the difference?
Girls will definitely talk about their problems more openly (than guys, no idea about how it compares to US women). Guys will probably tough it out to a degree. It really depends on the person and the more local culture (I found people in the South of England very polite, but uncommunicative compared to Scotland).
It's a recent development, and is definitely not true of everyone. My father will probably never see a therapist, even though he most definitely could use one.
You aren't "broken" because you go to a therapist.
Normal as in I see references to it in popular culture, US TV shows and films. A Hacker News article, which is international, but must have a heavy US bias.
As I say it seems somewhat strange to me. (I hope this doesn't come across as offensive) but why would you go to a therapist of you aren't "broken" to some extent? (Maybe broken isn't the best choice of words, but I think you understand what I mean by it). It's not cheap to go to a therapist is it? It's not something we do over here. If it is more common than I realize then its not something we talk about.
I understand what you mean, but I agree that it is not the best word. I see the therapist like going to the gym in many ways. I have some things I would like to change about my body. I would like to lose weight and be more healthy, so I go to the gym. The same with my mental health. It goes up and down with life and it’s trials and tribulations, but I see going to the therapist as maintenance. It’s an hour I spend every week reflecting on my own mental state and talking about it with my therapist. I have anxiety and depression, but I do not think of myself as “broken,” at least not anymore.
Life is full of trauma and catastrophe. I think therapy is something most people would benefit from at at least some point in their life.
Therapy isn't really a "recent" development but its formality and evidence based research has really been refined to something to be proud of in the past 20 years. Yes, its been a shitshow up and down, but so was everything back in the day.
I wouldn't assume that people going to therapy fall under "more stress and broken". Anecdotally, I've known people that go preemptively to help guide themselves through new chapters in their life.
Therapists make sense to me given that in the western world, the role of our elders / guiding parental voices has been greatly diminished.
There's probably some spillover from the psychotherapy boom in midcentury America. In some circles it was (and probably still is) viewed more as advanced self-exploration than fixing some tragic brokenness. One tends to see therapy used by upwardly mobile urban professionals, as an example.
I personally think almost everyone would benefit from a good therapist, though stigma, cost and the view you're expressing are all probably huge obstacles.
True many people go for high levels of trauma ("broken" is probably a terrible word to describe a human) but many go for guidance or even just low levels of anxiety- the US works so many hours we don't have time for mental health and cooling off like other countries.
No one really talks about it but I think what you are lacking is our pro prescription drug culture.
I have a minor ADHD that could easily be ignored or worked around. But to stay competitive as a programmer I felt that I needed to to have Adderall to keep up with my colleges. So I went to the therapist.
When I got promoted into a position where I was required to present to rooms of 50 people... I sucked. I'm terrible at public speaking. Is that an anxiety disorder, or just a personal weakness? I don't know but either way a trip to the doctor and a prescription of Xanax later and I'm great at talking to a big group.
I've been married for 5 years and the wife noticed we don't have the same type of relations that we used to. Saw a marriage counselor for a few visits and she suggested I see a different kind of therapist who could load me up with a little blue pill. Now marriage problems are gone too.
Is that gross to you? Do you think we shouldn't take a pill for everything? Because a part of me in the back of my head, is like "WHAT ARE YOU DOING?". But the bigger part of brain is happy to go with flow. See a doctor for everything, and if I have doubts about the amount of medication I'm taking.... well, there is a pill to help with that too.
You didn’t see a “therapist” to get speed, downers, or penis pills. Therapists don’t prescribe medication. Psychiatrists, physicians, and other medical doctors (MDs) do.
I think it’s disingenuous to link people going to therapists in order to talk through their problems with your medication-centered problem-solving approach, or with drug-seeking behavior.
Americans have systematically destroyed / left the various community organizations and ties and/or interpersonal relationships that in the past would have been the place to go for these things. Like, after our seven miscarriages, people suggested a therapist, which we saw. We saw the top rated therapist in our area for pregnancy loss grief, but honestly, she was quite useless in comparison to our two sets of married in-laws (quite a rarity these days), our priest, our deacon, and our deacon's wife, who have been significantly more helpful simply by being there and being close to us.
The thing is that therapy can be bought, and Americans love spending money on things. You can't buy relationships. This is my -- admittedly completely unfounded -- explanation.
I think there's a lot of truth to your comment, but the other side of it is that voluntary community & interpersonal relationships are all self-selected and reciprocal, and so you get significant selection bias in their advice. Oftentimes, if you have persistent dysfunction in your life, your relationships are part of the problem, but you can't see that because those are the only folks you hang out with.
I can't imagine asking my high-school friends (who were largely potheads with no career ambitions beyond working retail) for advice about getting over my fears about starting a company, for example. Or, later in life, wondering why I didn't have a girlfriend when many of my friends were nerdy workaholic commitment-phobic males. It took a perspective beyond the folks I normally hung out with to break out of my old habits. These are different from acute crises like grief, which can usually be handled through sympathetic relationships.
A therapist's incentives are strictly financial (well, mostly - many of them do also want to help in general) and their time with you is bounded by 50-minute hours, and so they're oftentimes willing to take on clients that they would not be willing to have as friends.
I would agree with you. I would not go to my priest or my parents for business advice.
That being said, I think that calls into importance the civil organizations I mentioned before. How many young people are in any kind of community organization? I'd venture not many. The advantage of these kinds of community organizations is that they contain many kinds of people, united by being in the same place, rather than any common interest. The advent of social media has kind of decimated these organizations, but they're hugely important.
As a point of fact, my wife and I have met many friends through simply being in our local diocesan youth group. While we are both software engineers, most of the people we meet through the group are not. We know plumbers, teachers, entrepreneurs, video techs, etc. If we want perspective outside those of people just like us, we would just go here. If I wanted to start a business, for example, I'd just go to my men's club, and ask one of the older guys who own a business, instead of my parents or my friends. Why hire a therapist, when these guys are perfectly happy to help? All I have to do to get their advice and pick their brains is to take one evening off every month to have snacks, drink beer, and be their friend. I can not tell you how many old people in these organizations are happy to have some young blood show up and participate.
Don't get me wrong... if you don't have any of these in your life, then it makes sense for some situations to pay for it. But I do think it's sad we have all but eliminated these groups.
Nothing? At the time they helped us out, we had just joined the parish. Then we went on a six month hiatus because we were too depressed, but the other deacon invited me to drink beer, because he hadn't seen me in a while. Didn't even have to pay for the beer.
Of course, as somewhat active members of the parish, we help out a lot. We volunteer for the marriage prep ministry, and I often help the men's club out with various improvement projects, by contributing brute strength or woodworking skills. Not all 'tithing' is monetary.
FWIW, it helps if you find a parish that is associated with a religious order, where the members are vowed to poverty. Diocesan priests tend to be the ones with the most monetary ambition.
I can only speak for my own religious tradition (Protestantism, Australia) but as the son of a minister and a lifelong churchgoer, I've never seen money come into it. I think the trope about money-hungry evangelists certainly has some truth to it in some parts of Christendom, but when it comes to money the church as a whole really isn't the stereotype that some make it out to be.
Growing up in a church ministry household, the only time I ever heard my father talking about specific individuals and their financial support for the church was in situations such as when someone died and left a bequest they had to sort out. I imagine he probably did get some idea about the generosity or otherwise of some of our parishioners just through knowing them sufficiently well, but I don't think he'd ever let it show.
Of course, if my dad wanted money, he'd have stayed in accounting. As a software engineer, I was earning more only one year out of uni, even with only Australian-level engineer salaries, than he's ever earned at any point in his whole career.
I'm not saying they're money hungry, but it's extremely uncouth to show up every Sunday and not contribute. I was pointing out that these free services aren't actually free.
In my experience as a lay minister, I've generally seen an inverse relationship between contributions (time/effort/involvement, not just financial) and support needs, though there are definitely exceptions.
It may be that the involvement strengthens resilience or strengthens the support network, or an inverted cause and effect, etc.
Its becoming less stigmatized in the US, but it is present all over the world. My parents are both doctors (therapists), my uncle is a doctor (therapist), I have a handful of family I'm aware of who see therapists (not due to any crazy trauma or anything, just not stigmatized in a family business).
My father traveled all over the world sharing evidence based research with other international researchers in India, Japan, Korea, Russia, Germany, Spain, etc. Now he focuses on research oversight in the US but trust me, its very common, just not talked about due to stigmas surrounding mental health.
I think that a big part of this is that the "willing to admit it" part has become slightly more de-stigmatized, particularly after the recent suicides of some high-profile celebrities.
There's a vicious cycle at work here: People don't want to talk about going to a therapist since they are worried about being seen as "broken", so people who could benefit from therapy don't seek it out because they don't know anyone else who does, so it becomes more unusual, which creates more of a stigma against it
Edit: I also think that perceptions are changing around, what, specifically, is broken. Your post mentions "broken people", but if a person had cancer, or a fractured bone, or an infection, we wouldn't say that the person is broken. Similarly, I think we need to realize that people with mental health issues have issues with brain chemistry, rather than being broken people.
Many indigenous cultures regularly practice community and individual healing. So, healing is an accent tradition but the new part is paying for it and some of the more modern methodologies as the older traditions are more somatic and spiritual.
Anecdotally, it’s still taboo to go to a therapist in the U.S., but I think it shouldn’t be. The other child comments here are pretty good, I’ll just add that I’m familiar with a few psychology students and in their training they’ve helped a lot of undergrads get through some tough problems.
I never considered therapy as an option within reach at any point in my life, but I think it could have and can in the future help me, and 90% of people.
If you’re opposed to it, you can actually think of it as better understanding your brain and leveling up your life and career. PhD students go through 5-8 years of training on understanding the brain and human behavior. Even if one doesn’t have serious problems, it’s likely a huge help.
In my anecdotal experience, Europe is behind the US, i.e. "more ashamed" as you put it -- the benefits of therapy just haven't sunk into culture generally.
But to echo other commenters, it's not exactly something people are very open about in the US either, you wouldn't usually tell anyone but your very closest friends, and sometimes not even them.
But I think there's more widespread acceptance in the US that therapy has value for many people and isn't quack science, while many Europeans are quicker to reflexively dismiss it or stigmatize it as for people who are "broken". Therapy doesn't have anything to do with being broken.
Again, just anecdotal from the people I know and attitudes I've heard... zero data to back it up.
As another anecdote, in my < 30 (Dutch) urban surroundings people seem to be quite open about going to therapy and even talking about the details and what medication that might be on.
I think the biggest factor is that increased mobility in the US means people are likely to be far away from family support systems. (To give you an idea, it's a longer trip from where I live to my parents than London to Moskow, despite us both being in the US).
I think marriage counseling being so big is also affected by the heterogeneity of culture; it's very likely that you and your spouse have quite different backgrounds and expectations across a gamut of things.
Most therapists can't help you, but mean well and don't know it, so if you're not seeing dramatic improvement after 6-8 sessions, find a new therapist. If you find it hard to break up with your therapist, that means they're really doing a bad job, and you should definitely find a new therapist.
Also, don't be impressed by credentials (PhD, MD, etc).
Hey incredibly rude, self-centered internet comment troll, if therapy doesn't work for you please don't try to spoil the experience for someone else. Evidence based research into efficacy of CBT (cognitive behavioral therapy) shows its response rate is higher than alternatives and especially beneficial for: anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. AKA, all your bullshit!
It is true that you need to click with your therapist- ask trusted friends who they see. Don't disclose to coworkers/bosses/work about seeing a therapist because its still stigmatized, case in point the idiot who posted the comment I'm replying to.
Credentials are important as to how/where therapists received training- and the difference between PHD, MD and other titles are CRITICAL to differences in psychiatrist vs psychology, etc. Some prescribe medicine, some don't, some shouldn't, some are quacks.
Find them based on reputation and perform your own checks to satisfy your concerns. Therapy is really healthy :)
Your own comment would have been a lot better without its first sentence and that "idiot" clause :) I didn't find the parent's comment rude or trollish.
It seems clear that therapy can help people. It also seems clear it is not a panacea, and that it can depend on both the person seeking therapy and the therapist, as well as the reason for therapy. It sounds like the parent was sharing their own experiences, which are just as valid as your own.
If we elevate therapy and therapists to be beyond criticism, all we end up with is a cult. Take the parent's comment on credentials and licensing: I'm sure that we want our therapists to be licensed, using evidence-based techniques, but that doesn't mean all credentials are created equally, or that because someone has credentials automatically means that they can be helpful to you personally.
> Be civil. Don't say things you wouldn't say face-to-face. Don't be snarky. Comments should get more civil and substantive, not less, as a topic gets more divisive.
> When disagreeing, please reply to the argument instead of calling names. "That is idiotic; 1 + 1 is 2, not 3" can be shortened to "1 + 1 is 2, not 3.
> Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
> Please don't use uppercase for emphasis. If you want to emphasize a word or phrase, put asterisks around it and it will get italicized.
(so put asterisks around the words critical and aka)
---
I only cited the guidelines that I believe you're in violation of. Your comment does show substance and it'd be more of a joy to read if you show that substance through editing your post so these guidelines violations aren't applicable anymore.
> The people it doesn't help are the people who put no effort into the process.
I’ve heard this repeated a lot. I have no doubt this is true for some people (maybe even the majority of people for which therapy doesn’t work, I don’t know). However, I wouldn’t want to claim this is the only reason. Especially since it’s a great effort for many people to even make it to therapy in the first place. They are making an effort. And it’s disheartening to then turn around and tell them they’re the problem if it doesn’t work.
If merely getting someplace is a great effort, they are in need of medication from a psychiatrist. They aren't candidates for therapy if that's the extent of their participation.
That's so untrue I literally dropped my jaw. Any therapist that treats anxiety can tell you it's extremely hard for some therapy needing patients (who, yes, are on medication) to make appointments. My wife included.
Speaking from experience it was incredibly hard to start. I waited 6 months between when I knew I had a problem before I made a concerted effort to find a therapist. Talking to another human being about my internal state took a lot of effort. I had to push through it.
I was one of those you speak of, that merely getting there was a great effort. Therapy did me immense amounts of good, where I can thankfully live a reasonably normal, content life today. But, starting out, you better believe it took everything I had just to get up the will to drive there, and even sit there, and nothing more.
I don't think you understand how much of a breakthrough it is for some people to even get to this point, and how _fragile_ things can be at that point, either. Just even getting someone to agree to sit down with a therapist can be a massive step for them - to finally start working to confront things.
Psychiatric medication does not provide a magic pill that restores your will and motivation. If only it did! Things would be so much easier, and I could have saved a lot of time on therapy.
I go a step further and think that with psychiatric medications there’s a chance to get worse without you even noticing that’s happening. Meanwhile, talking have no side effects.
OP probably didn't mean most therapists can't help anyone. They mean most therapists can't help you. As in part of what you have to do is find a way to connect with your therapist. It's impossible to connect with most people you meet.
After some false starts with other therapists, I was lucky to stumble on to one who focuses on short-term intensive treatment for anxiety—he specifically avoids long-term talk therapy. His belief is that two-thirds of patients who seek treatment for anxiety are ill-served by long-term treatment or medication.
I'll say this: he managed to get me stable in a fairly short amount of time. The sessions were so mentally taxing I often just went home instead of going back to work for the rest of the day, which is probably a sign they were working.
I'm wondering if a barrier to more people seeking help is the appointment vs walk-in option - how many more people, if they could see a therapist like they could go to a urgent care center, would do it?
People do try to use therapy as an urgent care center. People go to a therapy for help not committing suicide or harming someone else. It is a terrible idea. They can and should go to an actual emergency room.
San Antonio has found that emergency rooms are ill-equipped for this. Nurses and ER doctors are not generally mental health professionals. The city, county and various other authorities have built a sprawling system of mental health care facilities, partly designed to funnel people out of emergency rooms and into dedicated centers with staff trained in those situations.
> Take the Restoration Center, a big, boxy building on the edge of downtown. It’s a point of entry for people in psychiatric or substance abuse crises, mostly for those who lack health insurance. In the past, they went straight to emergency rooms or jail. Now many come through here — some 2,400 people a month.
> Open 24 hours a day, seven days a week, the center has a locked psychiatric ward for short-term stays, detox units, a medical clinic, and other services. Some patients walk in on their own. Others are brought by police or referred by hospitals. Anyone reporting suicidal or homicidal thoughts is seen within 15 minutes, day or night.
> In Massachusetts, there is no equivalent. Here, hospital emergency rooms function as crisis centers, and often ineffectively: Many people with severe mental illness end up being discharged without any promise of meaningful treatment.
This article leaves out 2 important types of providers, especially for California. These vary by state so I'm not surprised she left them out since it might not apply to her:
Licensed Marriage and Family Therapist (LMFT): In CA they have at least 3,000 hours of experience. Similar to LCSW except they have a Masters in Marriage and Family Therapy and not in Social Work.
Licensed professional counselor (LPC): Same as above but in more states than CA.
Also, Psychologists and Psychiatrists do not necessarily have more experience since they can practice the day they graduate. What is important is the amount of time they have been practicing.
YMMV but I live in a high-cost-of-living area and here if the therapist will take insurance that's almost a guarantee that they are not going to be good; mainly because in order to make a living at the rates insurance pays they have to take far more clients than a good therapist would consider reasonable.
This, combined with the fact that there is enough disposable income floating around to pay good therapists out-of-pocket means good therapists will just not take insurance (though you may have some success getting reimbursed). If you can't afford, many of those good therapists will find ways to help you pay, and perhaps even offer you a bit of a break in their rates[1]
1: One psychologist I know personally quit a non-profit to start a private practice after determining that they could do better work and make more money by charging a high rate, and doing pro-bono work for poor people who really needed help.
So if we are trusting therapists to manage our psyche, does that mean therapists have the most stable and well managed personal lives? Are they some sort of strange philosopher-king like super category of humans? I’d love to see a large statistical survey of all the psychologists/therapists in Europe or North America and how their personal lives are happening.
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[ 2.9 ms ] story [ 157 ms ] threadMy advice is to go to http://www.brokenbrain.com before you make a decision.
https://news.ycombinator.com/newsguidelines.html
They might (They do, this has happened to me, and the end result was not getting care I needed, but anyway) suggest you not inform them of your insurance, then it's your fraud, not theirs.
The student are in their last year of training. The conversations are recorded, and listened to by a licensed therapist.
I found the $350 hr. "Doctor" to be just as effective as the $15 hr. student therapist. (The sessions are 50 minutes)
In all honestly, I didn't find therapy helpful, but you need to go through it in order to realize yourself if it has any value.
Oh yea, in order to see most Psychiatrists, they want you to see a MFCC first.
Then they usually put you on a drug that takes six weeks to work. They never worked on myself. I must have tried 10 different tricyclics/heterocyclic anti-depressants. Nothing helped. I'm now on two very addictive medications, and trying to taper off them. I just have a feeling my Psychiatrist is getting ready to retire.
I'll apologies in advance to the Psychology students. I know the profession means well.
You sound like a caring husband. That's Huge. Having an emphatic person in your life is so important.
In my case, my problem was debilitating anxiety, and when my life fell apart because I went from the most capable guy in a room to a trembling mess. That's when the depression hit. When the depression hit, I was kinda relieved, but it just stayed there.
I ended up seeing a a few Psychistrists. It's so much of an art, even though they had so much science in school. And yes--most medicine relies on placebo too. I know.
I've probally said too much now?
My wife is a therapist and tries to prevent this by being as transparent as possible. She posts her rates, her calendar, and makes it very clear that she is private pay only on her website. By the time someone reaches out to her, they usually know that it is going to work because they have had the opportunity to see all of that information.
- Gender. Consider what gender you might be more comfortable with. Many of my male friends prefered female therapists, I personally felt like I was talking to a maternal figure and found I was better off with a guy. No shame in either choice.
- Trial period/multiple options. When I first moved to my current city I made appointments with multiple therapists, even seeing two simultaneously for a few weeks. You want to be comfortable with them and it can be very hard to tell from one session. This is obviously very insurance dependant though.
The other thing I'd include is that it's helpful to realize you're not trying to find a best friend. You're looking for a therapist, and how they can help you is a lot different from other relationships you might have had with people in the past. Once I realized that, it made it easier for me to adjust and find someone that fit me best, rather than someone I had to like, or enjoy my time with, or other "normal" benchmarks you tend to look for otherwise.
Broad agreement among whom? As with MDs, I would expect several complex trade-offs. Particularly between the value of medical (and life) experience against the value of being trained with the current science and treatment methods. For therapists I would also expect more significant trade-offs due to the difficulty of building strong therapeutic relationships across large age differences for some patients. Are you aware of any studies on the issue?
1: Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care - Wampold, Bruce E.,Brown, George S. (Jeb) Journal of Consulting and Clinical Psychology, Vol 73(5), Oct 2005, 914-923
2: Huppert, J. D., Bufka, L. F., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2001). Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder. Journal of Consulting and Clinical Psychology, 69(5), 747-755.
When using age as the predictor I'd imagine time spent practicing is the latent metric actually being measured. You can't have 10 years of experience at age 25. That said it seems silly to use age when time spent practicing is a readily observable value.
Its a mixed bag on age. Younger, I think, is better due to both learning more recent research and also continuous education. Relatableness is a factor. Again, all anecdotal.
I've seen more therapists in my lifetime than I care to admit. But something like this would have helped a lot when I was starting out.
The casual approach does a really nice job at breaking things down and explaining parts of the process, without feeling like it's being dumbed down at all. It makes it feel very approachable, which is very welcome, given how daunting it felt (at least for me) starting out.
I cracked up at "My therapist is dull and doesn’t laugh at my cat memes. Should I keep seeing them for therapy?".
That’s $1000 per week, I cant afford that and I’m confident in my extreme thoughts getting worse and there’s nobody I can talk to about extreme vengeful hurtful thoughts and once a month or even once a week isn’t going to help when I’m genuinely asking for 4 sessions a week but insurance will never cover that so I’m stuck having to pay out of pocket and as I said this once a week is just not enough and so I’m stuck with my thoughts where only every now and then I can make a rational thought and the rest of the day is filled with unimaginable extreme pain and extreme thoughts.
And worse, therapists won’t reduce their price from $250 per session hour for these extra 4 sessions per week that I’m requesting, because, obviously $1000 per week (for 4 sessions) is a lot of money for them. This industry turns into a sham when therapists can charge $1000 per week to the man scraping by (but looks healthy enough to give the impression he can afford that amount)
1. What therapy is
2. How therapy fits inside a broader context of other kinds of practice - counseling, psychiatry
3. Some common misconceptions
4. How to go about a search process
Bookmarked to send to friends who are hovering in the general vicinity of finding a therapist in the future.
Pedantic alert: I know it isn't you, but your wife... but MFT degrees don't "specifically on couples and family therapy." The degree is just named that because the license is named that. The programs cover individual, couples, and family therapy but since the license isn't named that the programs aren't named that.
Does the US culture there produce more stress and broken people, or us Europeans just more ashamed of admitting to this sort of thing or is it something else?
Talking about problems and issues with someone is important. If it's not friends, or a community leader (priest/rabbi, etc), a therapist is a great option.
Do Europeans talk about their problems with their friends more openly? Perhaps this is the cause of the difference?
It's a recent development, and is definitely not true of everyone. My father will probably never see a therapist, even though he most definitely could use one.
You aren't "broken" because you go to a therapist.
As I say it seems somewhat strange to me. (I hope this doesn't come across as offensive) but why would you go to a therapist of you aren't "broken" to some extent? (Maybe broken isn't the best choice of words, but I think you understand what I mean by it). It's not cheap to go to a therapist is it? It's not something we do over here. If it is more common than I realize then its not something we talk about.
Life is full of trauma and catastrophe. I think therapy is something most people would benefit from at at least some point in their life.
Therapists make sense to me given that in the western world, the role of our elders / guiding parental voices has been greatly diminished.
Edit: looking at the other comments I am not the only one assuming this :
"That is a significant amount of work to engage in for someone who is already in a compromised mental state :'( "
I personally think almost everyone would benefit from a good therapist, though stigma, cost and the view you're expressing are all probably huge obstacles.
I have a minor ADHD that could easily be ignored or worked around. But to stay competitive as a programmer I felt that I needed to to have Adderall to keep up with my colleges. So I went to the therapist.
When I got promoted into a position where I was required to present to rooms of 50 people... I sucked. I'm terrible at public speaking. Is that an anxiety disorder, or just a personal weakness? I don't know but either way a trip to the doctor and a prescription of Xanax later and I'm great at talking to a big group.
I've been married for 5 years and the wife noticed we don't have the same type of relations that we used to. Saw a marriage counselor for a few visits and she suggested I see a different kind of therapist who could load me up with a little blue pill. Now marriage problems are gone too.
Is that gross to you? Do you think we shouldn't take a pill for everything? Because a part of me in the back of my head, is like "WHAT ARE YOU DOING?". But the bigger part of brain is happy to go with flow. See a doctor for everything, and if I have doubts about the amount of medication I'm taking.... well, there is a pill to help with that too.
I think it’s disingenuous to link people going to therapists in order to talk through their problems with your medication-centered problem-solving approach, or with drug-seeking behavior.
The thing is that therapy can be bought, and Americans love spending money on things. You can't buy relationships. This is my -- admittedly completely unfounded -- explanation.
I can't imagine asking my high-school friends (who were largely potheads with no career ambitions beyond working retail) for advice about getting over my fears about starting a company, for example. Or, later in life, wondering why I didn't have a girlfriend when many of my friends were nerdy workaholic commitment-phobic males. It took a perspective beyond the folks I normally hung out with to break out of my old habits. These are different from acute crises like grief, which can usually be handled through sympathetic relationships.
A therapist's incentives are strictly financial (well, mostly - many of them do also want to help in general) and their time with you is bounded by 50-minute hours, and so they're oftentimes willing to take on clients that they would not be willing to have as friends.
That being said, I think that calls into importance the civil organizations I mentioned before. How many young people are in any kind of community organization? I'd venture not many. The advantage of these kinds of community organizations is that they contain many kinds of people, united by being in the same place, rather than any common interest. The advent of social media has kind of decimated these organizations, but they're hugely important.
As a point of fact, my wife and I have met many friends through simply being in our local diocesan youth group. While we are both software engineers, most of the people we meet through the group are not. We know plumbers, teachers, entrepreneurs, video techs, etc. If we want perspective outside those of people just like us, we would just go here. If I wanted to start a business, for example, I'd just go to my men's club, and ask one of the older guys who own a business, instead of my parents or my friends. Why hire a therapist, when these guys are perfectly happy to help? All I have to do to get their advice and pick their brains is to take one evening off every month to have snacks, drink beer, and be their friend. I can not tell you how many old people in these organizations are happy to have some young blood show up and participate.
Don't get me wrong... if you don't have any of these in your life, then it makes sense for some situations to pay for it. But I do think it's sad we have all but eliminated these groups.
>our priest, our deacon, and our deacon's wife
How much do you tithe per week? Don't kid us by implying they'd give you that support if you weren't a paying customer.
Of course, as somewhat active members of the parish, we help out a lot. We volunteer for the marriage prep ministry, and I often help the men's club out with various improvement projects, by contributing brute strength or woodworking skills. Not all 'tithing' is monetary.
FWIW, it helps if you find a parish that is associated with a religious order, where the members are vowed to poverty. Diocesan priests tend to be the ones with the most monetary ambition.
Growing up in a church ministry household, the only time I ever heard my father talking about specific individuals and their financial support for the church was in situations such as when someone died and left a bequest they had to sort out. I imagine he probably did get some idea about the generosity or otherwise of some of our parishioners just through knowing them sufficiently well, but I don't think he'd ever let it show.
Of course, if my dad wanted money, he'd have stayed in accounting. As a software engineer, I was earning more only one year out of uni, even with only Australian-level engineer salaries, than he's ever earned at any point in his whole career.
It may be that the involvement strengthens resilience or strengthens the support network, or an inverted cause and effect, etc.
My father traveled all over the world sharing evidence based research with other international researchers in India, Japan, Korea, Russia, Germany, Spain, etc. Now he focuses on research oversight in the US but trust me, its very common, just not talked about due to stigmas surrounding mental health.
There's a vicious cycle at work here: People don't want to talk about going to a therapist since they are worried about being seen as "broken", so people who could benefit from therapy don't seek it out because they don't know anyone else who does, so it becomes more unusual, which creates more of a stigma against it
Edit: I also think that perceptions are changing around, what, specifically, is broken. Your post mentions "broken people", but if a person had cancer, or a fractured bone, or an infection, we wouldn't say that the person is broken. Similarly, I think we need to realize that people with mental health issues have issues with brain chemistry, rather than being broken people.
I never considered therapy as an option within reach at any point in my life, but I think it could have and can in the future help me, and 90% of people.
If you’re opposed to it, you can actually think of it as better understanding your brain and leveling up your life and career. PhD students go through 5-8 years of training on understanding the brain and human behavior. Even if one doesn’t have serious problems, it’s likely a huge help.
But to echo other commenters, it's not exactly something people are very open about in the US either, you wouldn't usually tell anyone but your very closest friends, and sometimes not even them.
But I think there's more widespread acceptance in the US that therapy has value for many people and isn't quack science, while many Europeans are quicker to reflexively dismiss it or stigmatize it as for people who are "broken". Therapy doesn't have anything to do with being broken.
Again, just anecdotal from the people I know and attitudes I've heard... zero data to back it up.
I think marriage counseling being so big is also affected by the heterogeneity of culture; it's very likely that you and your spouse have quite different backgrounds and expectations across a gamut of things.
Also, don't be impressed by credentials (PhD, MD, etc).
It is true that you need to click with your therapist- ask trusted friends who they see. Don't disclose to coworkers/bosses/work about seeing a therapist because its still stigmatized, case in point the idiot who posted the comment I'm replying to.
Credentials are important as to how/where therapists received training- and the difference between PHD, MD and other titles are CRITICAL to differences in psychiatrist vs psychology, etc. Some prescribe medicine, some don't, some shouldn't, some are quacks.
Find them based on reputation and perform your own checks to satisfy your concerns. Therapy is really healthy :)
It seems clear that therapy can help people. It also seems clear it is not a panacea, and that it can depend on both the person seeking therapy and the therapist, as well as the reason for therapy. It sounds like the parent was sharing their own experiences, which are just as valid as your own.
If we elevate therapy and therapists to be beyond criticism, all we end up with is a cult. Take the parent's comment on credentials and licensing: I'm sure that we want our therapists to be licensed, using evidence-based techniques, but that doesn't mean all credentials are created equally, or that because someone has credentials automatically means that they can be helpful to you personally.
> Be civil. Don't say things you wouldn't say face-to-face. Don't be snarky. Comments should get more civil and substantive, not less, as a topic gets more divisive.
> When disagreeing, please reply to the argument instead of calling names. "That is idiotic; 1 + 1 is 2, not 3" can be shortened to "1 + 1 is 2, not 3.
> Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
> Please don't use uppercase for emphasis. If you want to emphasize a word or phrase, put asterisks around it and it will get italicized.
(so put asterisks around the words critical and aka)
---
I only cited the guidelines that I believe you're in violation of. Your comment does show substance and it'd be more of a joy to read if you show that substance through editing your post so these guidelines violations aren't applicable anymore.
[1] https://news.ycombinator.com/newsguidelines.html
Who made you the expert to make this determination? The people it doesn't help are the people who put no effort into the process.
I’ve heard this repeated a lot. I have no doubt this is true for some people (maybe even the majority of people for which therapy doesn’t work, I don’t know). However, I wouldn’t want to claim this is the only reason. Especially since it’s a great effort for many people to even make it to therapy in the first place. They are making an effort. And it’s disheartening to then turn around and tell them they’re the problem if it doesn’t work.
I was one of those you speak of, that merely getting there was a great effort. Therapy did me immense amounts of good, where I can thankfully live a reasonably normal, content life today. But, starting out, you better believe it took everything I had just to get up the will to drive there, and even sit there, and nothing more.
I don't think you understand how much of a breakthrough it is for some people to even get to this point, and how _fragile_ things can be at that point, either. Just even getting someone to agree to sit down with a therapist can be a massive step for them - to finally start working to confront things.
Psychiatric medication does not provide a magic pill that restores your will and motivation. If only it did! Things would be so much easier, and I could have saved a lot of time on therapy.
After some false starts with other therapists, I was lucky to stumble on to one who focuses on short-term intensive treatment for anxiety—he specifically avoids long-term talk therapy. His belief is that two-thirds of patients who seek treatment for anxiety are ill-served by long-term treatment or medication.
I'll say this: he managed to get me stable in a fairly short amount of time. The sessions were so mentally taxing I often just went home instead of going back to work for the rest of the day, which is probably a sign they were working.
http://apps.bostonglobe.com/spotlight/the-desperate-and-the-...
> Take the Restoration Center, a big, boxy building on the edge of downtown. It’s a point of entry for people in psychiatric or substance abuse crises, mostly for those who lack health insurance. In the past, they went straight to emergency rooms or jail. Now many come through here — some 2,400 people a month.
> Open 24 hours a day, seven days a week, the center has a locked psychiatric ward for short-term stays, detox units, a medical clinic, and other services. Some patients walk in on their own. Others are brought by police or referred by hospitals. Anyone reporting suicidal or homicidal thoughts is seen within 15 minutes, day or night.
> In Massachusetts, there is no equivalent. Here, hospital emergency rooms function as crisis centers, and often ineffectively: Many people with severe mental illness end up being discharged without any promise of meaningful treatment.
Licensed Marriage and Family Therapist (LMFT): In CA they have at least 3,000 hours of experience. Similar to LCSW except they have a Masters in Marriage and Family Therapy and not in Social Work.
Licensed professional counselor (LPC): Same as above but in more states than CA.
Also, Psychologists and Psychiatrists do not necessarily have more experience since they can practice the day they graduate. What is important is the amount of time they have been practicing.
This, combined with the fact that there is enough disposable income floating around to pay good therapists out-of-pocket means good therapists will just not take insurance (though you may have some success getting reimbursed). If you can't afford, many of those good therapists will find ways to help you pay, and perhaps even offer you a bit of a break in their rates[1]
1: One psychologist I know personally quit a non-profit to start a private practice after determining that they could do better work and make more money by charging a high rate, and doing pro-bono work for poor people who really needed help.