
Finding a Therapist - danarch
https://www.moodcheckin.com/blog/finding-a-therapist
======
didgeoridoo
Shameless plug: my wife runs a psychology practice in Boston and wrote a
little free guide on this topic. PDF grabbable here:
[https://azimuthpsych.com/downloads/Azimuth_How_to_Find_a_The...](https://azimuthpsych.com/downloads/Azimuth_How_to_Find_a_Therapist_\[ebook\].pdf)

~~~
rhencke
This is actually really good.

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?".

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viburnum
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).

~~~
mikec3010
>Most therapists can't help you,

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.

~~~
Osmium
> 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.

~~~
mikec3010
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.

~~~
rhencke
This is false, and damaging to believe.

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.

~~~
lhuser123
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.

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collyw
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?

~~~
tathougies
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.

~~~
mikec3010
>Americans love spending money on things

>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.

~~~
ajdlinux
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.

~~~
mikec3010
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.

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darthlucio
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/](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.

------
rhcom2
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.

~~~
holman
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.

------
faitswulff
That is a significant amount of work to engage in for someone who is already
in a compromised mental state :'(

~~~
vinbreau
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.

~~~
didgeoridoo
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.

~~~
uxp100
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.

~~~
didgeoridoo
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.

------
intellectronica
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.

~~~
nickbarnwell
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.

~~~
diab0lic
> 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.

~~~
nickbarnwell
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

------
aidenn0
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.

~~~
cm2012
I've noticed this also. The best therapists avoid insurance plans

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JoblessWonder
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.

------
abledon
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.

~~~
leesalminen
Heh. I’ve thought that myself once or twice.

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dawhizkid
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?

~~~
canes123456
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.

~~~
saryant
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.

[http://apps.bostonglobe.com/spotlight/the-desperate-and-
the-...](http://apps.bostonglobe.com/spotlight/the-desperate-and-the-
dead/series/solutions/)

> 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.

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lokufda222
I wonder why nobody mentioned ratemds.com ? Is it not that well known or ?
(Not related to them in any shape or form btw)

~~~
notananthem
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)

