I’ve been struggling with a lot of personal problems lately related to anxiety and possibly depression. While I don’t think I am a danger to myself, I’m beginning to think that talking to a counselor could really do me some good.
I have tried going to therapy a couple times before, but have always stopped after the first session. Part of the issue is that I feel like I should be able to work through my problems on my own and that seeing a counselor feels like a weak move. I know I won’t be able to get the benefits of therapy if I’m not open to it, but I just don’t know how to come to terms with the fact that I need it.
Another issue is that I haven’t felt comfortable with any of the therapists I have (briefly) seen in the past. There are so many out there, so how can I possibly find one that is a good fit for me?
I’m really ready to improve my mental situation, but I don’t know how to get myself there. Any advice would be appreciated.
Ready to Talk
Dear Ready to Talk,
The commonly held idea that going to therapy shows weakness couldn’t be more wrong. What could be more courageous than examining your life—your experiences, emotions, behavior, and history—in a new, possibly more honest way? What could be more heroic than challenging yourself and perhaps changing your outmoded habits, unproductive assumptions, and accustomed ways of looking at the world? What could be more powerful than realizing that you may have choices about how to be, think, feel, and behave?
What’s weak is surrendering to debilitating—but treatable—problems like anxiety and depression. Why continue to accept the limitations imposed by these conditions on your capability to enjoy life? Why limit your ability to bravely and realistically move forward toward your goals (or possibly change them)?
Now, not everyone can make use of therapy or wants to, but when people have ongoing difficulties in their lives and relationships and yet disparage therapy, or maintain that it shows weakness, it’s often because they fear change, or are afraid to get to know themselves better.
It does sound like you’re ready to give therapy a try. Fantastic! Try to look at it as a voyage of discovery, and think of yourself as a kind of Christopher Columbus—only yours is a journey to discover yourself, rather than the New World. If you go into it with a mindset like this, you may find you take to it more readily than before.
That being said, people often find that they work better with some therapists over others, and finding someone you feel comfortable talking to is an important factor in having a successful experience.
For starters, here are some basics about practitioners: Psychiatrists are medical doctors. They can dispense medication, and are less likely to do “talk therapy” (or, if they do, it will be very expensive). You can also choose a psychologist, licensed at the doctoral level, or a therapist, licensed at the master’s or post-master’s level—like a social worker, counselor, or marriage and family therapist. While psychologists and therapists can’t write prescriptions, they can refer you to a psychiatrist for medication and continue to see you for therapy, if they think it would be beneficial (and if you agree).
There are many ways to find a therapist—and the APA (American Psychological Association) and the NASW (National Association of Social Workers) suggest the following:
- Talk to trusted family, friends, or clergy about professionals they may know.
- Ask another healthcare provider, such as your doctor, for a recommendation.
- Consult a local or state mental health association.
- Contact an area community mental health center or clinic.
- Use a referral/locator service from a national professional organization for therapists (Psychology Today also has a service).
- Check with your health insurance provider for a list of mental health providers.
If you use a locator service or your insurance provider’s listings, you’ll likely still have many professionals to choose from. Google them, read their bios, and get a feel for which ones you might connect with to put together your short list.
Then, set up phone calls to talk with people before you meet with them in person. I’d say it’s good to talk to a few therapists, but don’t use your search as an excuse to avoid committing to starting the work.
Ask some questions—not only to get a sense of where the person’s expertise lies, but also to see how comfortable you feel with him or her. Try questions like:
- What is your training? Are you licensed? How many years have your been practicing?
- I have been feeling [anxious, depressed, overwhelmed, angry, frustrated, whatever], and have been having problems with [my job, marriage, children, eating, sleeping, or your specific issue]. What’s your experience working with these problems?
- What’s your area of expertise? (e.g., anxiety, depression, couples, children, families, grief)
- What kinds of treatments do you do, and how effective have they been?
- What are your fees? (Most therapists base their fees on a 45- or 50-minute session.) Do you take my insurance? How do you bill?
Some therapists (and mental health clinics) will consider something called a “sliding scale,” so if the therapist gives you her fee and you feel you can’t afford it, say so. She may offer to lower the rate.
Really listen when your potential therapist answers your questions and, if you find him or her impatient, arrogant, or otherwise unlikeable, move on. Obviously, no one is going to spend an hour with you without getting paid, but a therapist who refuses to answer at least some of these questions on the phone, insists on a paid consultation to answer any questions, or says something like, “I’m a strict Freudian” (or strict whatever) may be less flexible than you want. Many modern clinicians adapt their approach to the needs of the individual and draw from many different schools of thought and practice, ranging from psychodynamic, to cognitive/behavior, to interpersonal, to Gestalt, to “whatever helps.” If you’re so inclined, there are also practitioners of “creative” approaches, like narrative, music, dance, art, and drama therapy.
Remember that a person can be highly experienced and impeccably trained and still not be right for you. In my view, a great deal of therapy has to do with rapport, compassion, and the therapist’s natural instincts and talent. Obviously, these can be hard to discern, but pay attention to your gut.
Congratulations on taking this important step in your life. I urge you not to become frustrated in your search and not to give up before you find someone. Obviously, you don’t want to go with someone who seems really awful to you, but remember that we’re also human beings. So keep an open mind—and realize you may need to give it a session or two to really judge if you can work with a person.
I wish you all the best,
Have a question for Fran? Email firstname.lastname@example.org.