
Ask HN: How to find a mental health professional? - throwaway-18613
We&#x27;ve been having a lot of great discussions here on HN lately about mental health, and the suggestion to seek professional help rings true.<p>But, depressed and burnt out and feeling isolated, the project of even finding a therapist in the first place can be overwhelming.<p>I live in a large city, where there are literally thousands of therapists, psychologists, psychiatrists, licensed social workers, life coaches, you name it.  About half of them even accept my insurance.<p>How does one even begin to narrow the options down?  After asking my GP and getting no suggestions, I&#x27;m at a complete loss.
======
whitepoplar
I've mentioned this elsewhere, but having gone through long, severe periods of
depression, I'm convinced that seeking help needs to be declarative, not
procedural. One shouldn't have to go through the multi-step process of:

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.

~~~
groby_b
Nope. You can't solve it declaratively, because for therapy to work, you need
to find a therapist that "clicks" with you.

Pick a therapist. Tell them you're shopping, you'd like both a trial session
and recommendations for alternatives. If they're not willing to do that,
they're not the right person. Most are.

~~~
whitepoplar
I agree with you that it's important to find a therapist that "clicks" with
you, but I'm convinced that taking the first step and making an appointment is
the hardest part. An order of magnitude harder than making a second or third
appointment. Therefore, I think the most important problem in mental health is
getting people through the front door and sitting in someone's office.

~~~
entee
I think the concerns could be harmonized with the OP by simply spitting out,
"Here are 5 people to call" with perhaps a little info on their approach. This
could of course link to a description of what those approaches mean, i.e. "CBT
seeks to change mental habits in the moment by teaching tools to rethink and
process reactions as they happen" etc.

edit: Typo

------
chickenfries
I often offer up my therapist's practice as a recommendation to friends.

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.

------
kec
If your GP can't offer you a referral, honestly the best you can really do is
just pick a psychiatrist or psychologist nearby who accepts your insurance.
Either can diagnose you if there is something to be diagnosed. Both can offer
therapy, only psychiatrists can proscribe medication.

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.

------
news_to_me
If you live in Seattle, I can recommend the Women's Therapy Referral Service.
It's not just for women patients — just the therapists are all women. The nice
thing is they give you three therapists to have a session with, and you can
choose one to continue with (or not).

I'm sure similar services exist in other cities.

[https://therapyreferral.org/](https://therapyreferral.org/)

~~~
throwaway-18613
This is great! How would one locate such a service in another city?

------
dougmccune
Just one note regarding insurance and cost. I think the number of therapists
that are covered under insurance plans varies dramatically region to region.
The bay area, as an example, seems to have an incredibly small number of
therapists that are in-network on insurance plans. It seems like the majority
of psychologists do not work directly with insurance companies, because
there's so much demand and the insurance companies are such a hassle and pay
so much less than market rate.

The market rate for a therapist these days is something like $250/hour here in
the bay area. Many insurance plans will reimburse if you submit an invoice
from a therapist. The reimbursement rates vary greatly, sometimes zero,
sometimes 50%, sometimes 80%, etc.

So all that to say that it's a super shitty system where you can't know ahead
of time how expensive therapy will end up being for you, and the therapists
themselves typically also don't know ahead of time (although they can
certainly have a sense of which insurance companies typically reimburse at
different rates).

Source: my wife is a psychologist in SF who doesn't directly accept insurance
but the majority of her patients receive some level of insurance
reimbursement.

------
ghufran_syed
If you could say what city (and country) you are in, it might make it easier
to give recommendations instead of having a completely abstract discussion :)

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.

~~~
throwaway-18613
New York, fwiw. And yes, I'm functional in a "get out of bed every day and go
to work and put on a good front" sense, and would prefer to avoid medication
if possible.

~~~
vthallam
I added a comment elsewhere about Zocdoc. If you are in New York, Zocdoc works
great for a start.

~~~
throwaway-18613
Thanks. My experience with ZocDoc for other specialties has been (for lack of
a better term) disappointing.

------
trcollinson
Well, over the weekend I wrote up a bit about my struggle with burnout and
mental health. I got about a bajillion fake internet points for my comments so
I guess people wanted to know what I have to say. I’ll go ahead and add a bit
about how to find a mental health professional. I hope it helps a bit

First, if your general practitioner doesn’t have even one suggestion at all,
I’d suggest thinking about a new general practitioner. This is quite like
saying “my leg has fallen off can you put it back on?” And your doctor saying
“well I can’t and I don’t really know anyone who can. Have you tried google?”
If that sounds absurd, it’s because it is. Mental health is important.

Second, if you love your GP, try asking around other people you know. Ask on
Facebook or twitter or LinkedIn for your friends recommendations. Don’t be
embarrassed. Mental health is important.

If you are a member of a religious or social organization, ask the leaders of
that. Almost invariably religious leaders have good recommendations. They talk
to a lot of people and often have a good understanding of mental health issues
and who can solve them.

You can also ask your insurance. Insurance companies often have a referral
service. It won’t be as personalized but it will have some help.

Now once you hit up all these groups then make a list of 5-10 therapists and
call them. Have a few minutes phone conversation. See what they are like. Then
make an appointment.

Whatever you do, please don’t give up on finding someone. It will help. It’s a
good thing.

~~~
craftyguy
Wow, that is a lot of work to find a GP that _might_ work with you. Why is it
this difficult, and could it be made less difficult?

Taking an analogy you made, if my leg fell off, there are quite literally
thousands (or tens of thousands, or hundreds of thousands) of places in the US
that could legitimately help you.

The mental healthcare landscape is more like "there are thousands, but only a
few you mesh with after expending a lot of effort to find them can probably,
maybe help". Wtf.

------
kenforthewin
Am I the only one who thinks HN is an awful place to ask for mental health
advice? If you asked your GP and got literally no suggestions, please dear
God, find a new GP.

~~~
meko
People without gov issued health insurance don't know the pain of bouncing
from shitty doctor to shitty doctor. They see so many worse cases than you
every day, 'sad gringo probably should off himself, the ingrateful lout' is
the attitude you get when you try to discuss your problems. Have fun
explaining the depth of your issues in a 2 minute pitch!!

------
throwaway819371
If you feel you would benefit from talking to someone, the type of person you
want to seek out is a therapist. Therapists can then help you decide whether
you should also be seeing a psychiatrist for medications.

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.

------
foodstances
[https://www.psychologytoday.com/us/therapists](https://www.psychologytoday.com/us/therapists)

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.

~~~
throwaway-18613
Yeah, that's the site that returned an intractable list of ~2500 options in
NYC, and that caused me to shut down the last couple times I looked for help.

------
omegaworks
Sometimes your employer offers a service called an EAP (Employee Assistance
Program) that can direct you to resources that are covered by your insurance.

Finding a good therapist is really a bit of trial and error. Put yourself out
there. See someone and do a gut-check. A therapist should work to establish a
trust relationship and you should feel listened to. If they make you
uncomfortable or you think they will never be someone you can open up to, it's
probably not the right fit.

Full disclosure: I work at a company called Ginger.io[1] that provides 24x7
coach chat support and video therapy/psych sessions using a smartphone app. We
work with employers to provide services for their employees as a perk. Some of
our employer clients fully cover the cost of psychology and therapy, and for
others insurance covers our cost.

We make the set up process a bit more straightforward. We match you with a
care team, and make it easy to change it up if it's not the right fit.

1\. [https://ginger.io/](https://ginger.io/)

------
joe_hills
You could start by looking for professionals whose offices have convenient
locations for you.

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

------
killjoywashere
The good news is you went to your GP and typed up a request on Hacker News.
Some more good news is that in many cases depression is more of a life-state
issue than a neurochemistry issue (1). Further good news is that it can often
be resolved by talking to just about anyone. Finding the optimal therapist is
far less important than talking to some therapist.

There are a few advantages to talking to a licensed psychotherapist (clinical
psychologist, psychiatrist, etc): 1) they are bound by therapist-client
privilege; 2) in order to have gained licensure, they had to go through a
training process where they built a network of other professionals, not just
their own inbred type, but pharmacists, physicians, etc; 3) because they're
licensed they want to protect their license, so they will have a low threshold
to refer you to a colleague if they believe you need more than they can
provide.

Note, absolutely none of that has to do with their skills, their belief
system, or anything else. It's strictly to do with the rules that apply to
that piece of talking meat.

Given that talking with any piece of meat is better than not, I'd encourage
you to talk with a piece of meat that is subject to some social rules that
strongly encourage them to make sure you get the best care.

(1)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734449/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734449/)

------
amorphid
I needed a therapist about 5 years ago to deal w/ a specific event in my life,
and I asked my mom that question. She's a former therapist, and she taught me
a couple tips on how to find a good one. Instead of passing those tips on to
you, I suspect the advice might be different for each person, my suggestion is
to call a therapist that looks legit outside of your local area and how they'd
find a therapist. Also ask a couple questions about what you can realistically
expect in therapy, as you're likely going to discover it's much different that
you expected.

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 :)

------
stevenicr
I wish the comments here that suggest resources could also provide an amount
of privacy protection the various apps and sites listed have. It's hard to
tell who is keeping data for others with these various portals.

I also wish the psychtoday and healthgrades and others would actually call the
places listed in their pages, maybe an hour before closing listed hours, and
leave a message asking to be called back instructing them that leaving a
message or text is okay.

In my recent experience using some of the methods suggested by others here to
find help for a friend in this growing city, _not 1 of the twenty or so places
that I called answered the phone or returned a voicemail._

Maybe they are overwhelmed and not accepting new patients, maybe they heard
the willing to pay cash no insurance and decided not to return a call - but
this kind of data I think is more important for this kind of a directory than
say a listing of car repair shops.

Reading many of the comments here, I think it's fair to say that it's not as
easy as it should be in many places to get help.

I read an article recently saying some places may be coming out with a new
type of practitioner class that doesn't take the decade to get license and
that may provide more help in the future, but it also seems that more help
will be needed.

------
mindfulhypocrit
I’m a once computer science graduate now Licensed Clinical Social Worker in
private practice. For what it’s worth, I think finding someone you click with
is more than just an intuition or the luck of the draw. In clinical speak the
“match” you have with a provider is called the therapeutic relationship and
it’s inportant. In studies about the common factors across the board that are
correlated with successful clinical outcomes the therapeutic relationship is
more strongly correlated than even the therapeutic modality being used
(psychodynamic or CBT as examples). So finding someone that speaks your
language is important to having good rapport. But obviously scheduling that
first appointment is critical. I like to make that process smooth by
responding to email or voicemail inquiries within 48 hours if possible. Also
the first 30 mins consultation either over phone or in person is free of
charge to give the client a feel for what it would be like working with me no
strings attached. I structure this as 15 mins to explain what’s going on,
history and questions I have to also determine whether I am in fact a good fit
for them given my own training and experience. The last 15 are for my
impressions and reflections and some of my past experience to support that.
Afterwards if someone feels that they’d like to continue we make this a first
appointment by reviewing disclosure forms, agreeing to the terms of therapy
expectations, confidentially, etcetera and then go another 45 minutes to make
it a meaningful and complete meeting. Hope explaining some of my process at
the onset of taking on new clients is helpful to folks in tech looking for
support. In fact this is part of who I think I work well with. I’m in a major
tech booming city on the west coast, for folks wanting to ask more questions,
pm me.

------
metabagel
Like others, I recommend using Psychology Today to find a mental health
practitioner.

Some other tips for mental well-being:

Meditate. See if you have a meditation center in your area, or meditate on
your own. Shamatha meditation teaches you to make friends with your own mind.

Learn to recognize thinking traps. The Mood Notes app can be helpful with
this.

[http://moodnotes.thriveport.com/](http://moodnotes.thriveport.com/)

Thinking traps lead us down the path to negative emotions.

[https://www.anxietybc.com/sites/default/files/ThinkingTraps....](https://www.anxietybc.com/sites/default/files/ThinkingTraps.pdf)

The Mood Notes app will ask you how you are feeling, why you think you may be
feeling that way, and whether any thinking traps may apply to that situation.
Finally, it will ask whether you feel any better after having reflected. You
could do the same thing without the app, but the app helps to formalize the
process.

Reduce phone, computer, and television usage as much as you can.

Slow down. Go for walks. Put less pressure on yourself. Tell yourself that you
are OK, and everything will be OK. Breathe.

Good luck!

~~~
meko
Meditation is a passive activity and doesn't really have appreciable effects.
It's mostly new age woo.

~~~
metabagel
I understand why you would think that, but I'm not sure that you know what
meditation actually is. Have you ever meditated?

It's basically training your mind to just be present, without having to form
judgements all the time.

If you feel like giving it a try, here is a decent how-to.

[https://www.wikihow.com/Formally-Sit-in-Shamatha-
Meditation](https://www.wikihow.com/Formally-Sit-in-Shamatha-Meditation)

It's a good antidote for today's phone and interrupt-based culture.

------
jontranpham
Like others, I had a hard time finding a therapist to deal with my anxiety. My
6 month search added more stress to my life — I didn’t know where to go or
what to look for.

My frustration led me to talk to 200+ clients and therapists to learn more
about how this should work. I ultimately started a company to solve this exact
issue using my research (www.joinreflect.com).

Lots of great comments already, so I’ll just add a few things I learned if
helpful:

1\. According to the research, the biggest predictor of success in therapy is
fit (who you “click” with). There’s no right therapist for everyone. I suggest
first thinking about why you’re looking and what style of work you might be
interested in (e.g., do you want to talk through issues or find a
solution/change behavior?)

2\. Definitely review profiles/websites and see what the specific clinician
has experience with

3\. Orientation is a helpful filter to predict style, but it’s not nearly as
rigid as you may think. In reality, many therapists say they’re “client
centered” and can flow between orientations (e.g., CBT vs. psychodynamic).
Some specialities are more evidence-based than others (in academic setting),
but again, fit is most important

4\. There’s little practical difference between degree type if you’re looking
for talk therapy (MDs can prescribe medicine, doctorate level can do
assessments, associates are under supervision of a licensed clinician)

5\. Many therapists offer free 15 min calls to try, so def take advantage of
those (2-3 usually works if you have a targeted list). In the calls, ask
specifically how the therapist might work with you to treat the issue(s) and
see if the style matches what you feel comfortable with. Note, you might have
to call a bunch to even get 2-3 on the phone, especially if you want to use
insurance as many providers are full

Figuring out #1 can be hard. I started reflect (www.joinreflect.com) to use my
research to help others. reflect is live in the Bay Area, so check us out if
you’re here. We match you with therapists well suited to your needs based on
an algorithm I developed, and you can try each for free. 90% of those who do
find a therapist they like, and we have the largest self-pay network of
therapists in the Bay Area with ~300 clinicians and growing. In-person
sessions are $95, and you can use out-of-network insurance and HSA/FSA.

Even if you’re not in the Bay, feel free to email hello@joinreflect.com. I’m
the founder, so either I or someone on my team will get back to you ASAP. We’d
love to help any way we can. Good luck!

------
Fnoord
> I live in a large city

Do we have to assume you're from the USA?

Cause it is going to differ per country.

In The Netherlands it goes like this.

1) You look up your health insurance to check how you're insured. (Ideally,
you try to extra insure at end of year for whatever you think is necessary but
it is almost always never a net profit, or extremely small.)

2) Then you call up your doctor for an appointment. If you think your
discussion with your doctor requires extra time, tell that to the assistant.

3) You go visit your doctor and explain the problem(s) you have. He/she'll
likely give you a reference for a psychologist/psychiatrist (latter if you are
interested in using drugs such as anti depressants). This reference is
important for insurance reasons.

This is where the advice from me actually ends since I'm not your doctor! You
have found a mental health professional. From there, you can work out which
treatment you want, or get directed towards more/other professionals (I gave
some examples). One last piece of advice. Avoid all the paranormal BS. Stick
with conventional science (mindfulness _is_ conventional science, btw).

------
DenisM
Pick a friend you can trust and ask them to handle the whole thing, including
driving you to the first few sessions. If you're depressed any bit of extra
effort can derail your treatment, so don't tempt the fate.

Doesn't have to be a close friend, just someone responsible. Perhaps try a
parent with grown children - they would understand responsibility and have
time for you.

------
susiecambria
\--Example 1: The decision was made for me The therapist I went to after my
suicide attempt was an uncaring, unsympathetic bitch. (yes, I know I'm gonna
get kicked out of the feminist club.) I went to her _only_ because the
hospital staff released me after I said I would see someone and the
appointment was made. And let me digress a minute. The ER staff (Inova
Alexandria, Virginia) were even worse. They told me I was silly and unfeeling
and totally wasting their time, that there were people with real problems
there and I was taking time away from them. I kid you not. Back to the mean
therapist. I only saw her a few times.

\--Example 2: My doctor made a recommendation I diagnosed myself with clinical
depression (I took a quiz in Good Housekeeping but I had know for 20+ years
that something was wrong with me) and went to see my GP. In the appt with my
GP, I disclosed I had been molested and he recommended I see this woman (I
have no idea what her degree was, it didn't matter then). He warned me she was
a little touchy feely (not in that way!) but told me to stick with her for a
few sessions. The doctor was right. My therapist was wonderful and got me
through one helluva hard time.

\--Example 3: My new NP made a suggestion I'm not in the mood for therapy
therapy so talked with my NP and she suggested a local clinic type of thing.
She described what it's like, told me she visited several times, and has
referred other patients there. All are getting something out of it.

I've done pretty well getting recommendations/suggestions save for the crazy b
in Alexandria, VA. As a networker, I feel confident I could find someone by
asking around. BUT ONLY if I were not in crisis mode. If I need an emergency
sort of thing, my plan is to call my NP (I have her mobile) and her tell me
where to go when.

I do agree with the too many options comments. I have thought about just
checking myself in somewhere. THAT is a challenge. Is A better than B? Etc.

------
dustingetz
[https://www.psychologytoday.com/](https://www.psychologytoday.com/) Search,
randomly pick one close to you, call. Loop. You're probably trying to come up
with excuses not to do this because that's what depressed people do.

~~~
sam_goody
Or
[https://therapistexpress.com/therapists](https://therapistexpress.com/therapists)

Disclosure: I am affiliated.

------
navs
What helped me narrow down my options was how easily I could fit a visit into
my schedule. Because once you lower the barrier of visiting a therapist, the
more likely it is that you'll continue seeing them. Maybe find ones that on
the same route to work?

After that it's trial and error. The process almost mimics anti-depressant
medication. If you don't feel comfortable with the one you've got, move on to
another. That comfort factor is purely qualitative and you can only find the
therapist that works for you after wading through a few that don't.

I haven't found mine yet but good luck to you in finding the help you're
seeking.. Also, feel free to reach out to me if you want to talk and need a
sympathetic ear.

------
ta1357
As someone who has dealt with depression my entire life -- first therapist was
at age 12! -- I'd like to share something with you all that one of my
therapists shared with me.

The world is a depressing place, _if you view it through the lens presented by
the news media._ Maybe ditch all that noise, and see if you're happier.

I don't like the idea of being uninformed any more than anyone else does. But
this truly, _truly_ helped me, and I say it on the off chance that it might
help one of you.

------
freewilly1040
Speaking from (successful) experiences with therapy:

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!

------
newest_user_
Good luck. You may want to narrow it down to just psychiatrists who can see
you almost immediately. They can prescribe medicine if they feel it is
necessary.

I went this route and despite having decent insurance, every place that took
it was a 3-6 month wait for new patients. This is very disheartening to
someone who wants to get better but can't even imagine what 3-6 months down
the line looks like (have I killed myself yet? did I skip town? etc.)

(This was a past experience, I'm no longer depressed)

------
anandkulkarni
You can try [https://www.hellokip.com/](https://www.hellokip.com/), an app for
finding and managing your therapist.

------
kornish
If you live in SF, Two Chairs could be a good option
([https://www.twochairs.com/](https://www.twochairs.com/)). They're a practice
which strongly emphasizes the therapist matching component – and as others
have noted, finding a proper fit is hugely important for treatment. Not sure
if they're in other cities.

Disclaimer: no personal connection, but have heard very good things from
friends.

------
floil
This probably doesn't help OP but might help a reader who's facing the same
logjam and qualifies: see if your employer (or a family member's) offers a
benefit through [https://www.lyrahealth.com/](https://www.lyrahealth.com/) .
It is a super streamlined process that takes all the pain away of triaging
what's going on and figuring out which type of provider to use, and then
selecting one. I got it through my wife's employer even though I'm not on her
medical insurance. There's a diagnostic survey, then they suggest some
providers (with a strong default choice, which makes a huge difference), and
even help you draft the appointment request email. And they follow up to make
sure you get help. It still feels like you're owning the request for help,
which is pretty important -- it just puts the whole process on rails.

Depression can take away your ability to complete any of the above steps... I
know because I didn't get help for years because of the (minor, but thanks to
depression, major) hurdle of finding a suitable provider through my work
benefits.

Therapy works, y'all.

~~~
floil
Find out if it works for you by typing your employers name (or your
spouse's/parent's/etc - coverage seems to be for "family") here:
[https://care.lyrahealth.com](https://care.lyrahealth.com)

------
bb88
Having a friend who's a "shrink" (her words not mine), this is what I suggest.

First, I recommend a neutral therapist, i.e. one that's not affiliated with a
church or religion. I would also recommend getting one that's licensed, or
working under the supervision of a licensed psychologist.

Then they are basically going to fall into two categories: Cognitive
Behavioral, and Psychodynamic.

Cognitive Behavioral seeks to change your thinking patterns through conscious
awareness and behavior modification. Usually there is a limit, say 6-10
sessions with a series of goals to be met.

Psychodynamic seeks to help by helping you to overcome the emotions you may be
repressing or unable to deal with. This can be two or three sessions, say or
longer (months).

A psychiatrist may do either, and then may add a drug regimen to help you
balance your emotions.

All are popular, all work for different people.

Also pretty much all of them will be willing to meet with you to see if you
click and answer any questions, though some may not be able take on new
clients.

Edited to add:

Also, one thing my shrink friend complains about are "corporate" mental health
centers who declare the patient healed when their insurance runs out.

------
braindongle
Neighbor to neighbor, not medical advice:

Navigating the mental health care system in this country is difficult. From
what you've described, here's what I would do:

\- Start with an in-network therapist. My personal bias is to look for someone
with a PhD in clinical psychology, but the important thing is to get started.
Talk with your therapist about medication. They are trained to do this and to
get you do an MD (psychiatrist) if you agree it makes sense. They will take it
from there. Managing meds is basically what they do. (There are psychiatrists
who also do talk therapy. If they are good at both, it won't be cheap).

\- Do not feel at all obligated to stick with your first provider. This part
is hard, due to the awkwardness of firing your therapist. Therapy takes time,
but it may be clear after a couple of sessions that you are, e.g., with
someone who won't talk about solving practical problems and only wants to talk
about your upbringing, or the other way around. If you think it might be a
good fit, give it more time, but it's true: you _do_ have to click with your
therapist for it to really work, and there is no formula for that.

\- If you are not a danger to yourself or anyone else, and you are able to
take care of yourself (basic social functioning and providing for yourself),
then consider thinking about your care in terms of cost and benefit. If you
are having to make excuses to duck out of work, that's stressing you out, and
the therapy isn't helping, that's a bad c/b. If it's costing you an arm and a
leg, your mind is more important, but that's still a bad c/b.

If you are isolated and in constant pain, strongly consider staying in some
sort of care as a safety net, even if you can't find someone with whom you
really click.

------
DanBC
You didn't say what country, so I guess the US.

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...](https://www.amazon.com/Mind-Over-Mood-Second-
Changing/dp/1462520421/)

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/](https://www.moodgym.com.au/)

------
gwn7
Before even narrowing down the professionals; I would strongly recommend you
to question the nature of your problems and think about the possibility of
them being symptoms of underlying physical problems.

Most of the time and for most people the so called mental health issues are
only symptoms of chronic health conditions or a bad lifestyle. Digestive
issues, auto-immune disorders, hormonal imbalances, vitamin deficiencies,
excessive stress/unhappiness, a bad diet and similar conditions are all known
to cause "mental health" issues in the mid and long term.

I suggest you to review any other physical conditions you have and definitely
see a naturopath/nutritionist or a similar natural health practitioner beside
your therapist/psychologist/coach/whatever (if any).

Seeing a naturopath over a mainstream physician is important. As mainstream
medicine normalizes many health issues and usually fails to grasp chronic
conditions; it usually misses important clues regarding not-so-apparent
problems and is prone to declare that you "are fine" and "probably need to see
a psychiatrist". That is a way of saying that they have no clue.

The human body is a whole and usually the words of a therapist, or the weird
drugs of a psychiatrist fall short on restoring your sanity, according to my
experience. Please be very skeptic of the professionals who fail to exhibit a
broad knowledge on the human nature/body and the ones who strongly promote a
single "magic" method of healing, such as a single drug/herb, or bare
conversations, however "empowering", "motivational" or "insightful" they may
be.

Let me repeat: Check the hardware first for failures.

If all seems to be fine, and you are fit; you probably need to quit your
job/partner/town and seek new company/activities.

------
bradlys
You narrow it down by just making choices.

I was with United Healthcare at the time. Now I'm on Kaiser but have the same
guy. I went onto their website and used their doctor search tool. Looked for a
therapist that was close to where I lived. Saw that they probably fit the bill
reasonably well.

I called the phone number listed then scheduled a phone appointment to be done
with the therapist. The day came, they asked me what I wanted to see them
about and I explained. They said, "Alright, we can schedule a first
appointment and go from there." Scheduled it - met them. During that process
he explained pretty clearly what he expects out of patients and what he will
take on. I went through my little story of life and he's like, "Alright, time
is about up. Do you want to continue doing this?" I said yes and saw the guy
on a regular basis.

~~~
econochoice
Just a note about United: their directory of in-network medical professionals
is, frankly, horrible. If a doctor formerly took UHC, and no longer does, they
will stay in their directory.

It took many days and calls until a representative told me that the directory
is outdated and that I needed to confirm with each doctor/practice as to
whether they still take UHC.

Yes, this process is terrible if you are sick and in need of treatment.

------
gregorymichael
I'm a developer who has Type 2 Bipolar and ADHD, and I wrote a bit about
finding a mental health professional here: [http://baugues.com/find-a-
psych](http://baugues.com/find-a-psych)

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

------
lhuser123
The way I see it, is something like this.

When you want to become good at anything, one teacher is never enough. Heck,
depending solely in the teachers will not get you where you want to be, the
most effort will be on your part. Learn, practice, feedback, etc, repeat.

Similarly, one mental health professional, will not be enough. Heck, trust the
wrong one, and you could end up worse.

Try different options so that you start to understand the process. Learn as
much as you can from reliable sources. Understand that they are just humans.
Help them.

Let’s say that you have the economic resources to pay for various cessions a
month or a week. Even that, is not enough for the professional to really
understand you. That would not be humanly possible.

Learn. Read. Understand. Discover. Use the tool(the professional), don’t let
the tool use you.

------
ddebernardy
If you're depressed _because_ of burnt out and feeling isolated, you might
actually not need a mental health professional. Burn out (been there a few
times) comes from working too hard too long. Particularly on meaningless
things.

What you might actually need is a proper vacation. If your savings allow it,
take some time off - like a month or two, or three, or more. Travel somewhere.
Meet people as you do.

Also chew a bit on your life priorities. Do you want to stick to participating
in the glorified rat race you've been a part of to date, or is there anything
else in life (building a family? non-profit work? etc.) you'd rather
prioritize?

If you're still not re-energized upon returning from your time off, _then_
seek professional help.

------
throwaway000021
My primary advice would be that therapists/counsellors are NOT all the same.
You need to find one who works for you, and it is a very individual thing.
Actively plan to try 4 of them, and do 2 paid sessions with each before
deciding to continue with one.

Also be aware that IMO some counsellors/therapists are actually bad at their
job.... if you get the feeling that something really does not make sense to
you, then stop going to them and find someone else.

I've tried many and found a few really good ones and definitely some really
bad ones.

It's also true that some were good for a long while but then at some point
things changed and they no longer were effective for me, so things can change
over time.

------
davekerpen
It’s a huge Problem! That’s exactly why we just built UMA Health! In NYC only
now but expanding soon - we are a marketplace to connect people with
therapists, coaches and other mental health pros. -Dave Kerpen, CEO
Http://UMAHealth.com

------
Pamar
First of all, decide if you would prefer talking with a man or a woman. Just
choose what you think would make you more at ease. Then narrow down to 3-4
names (from google, yellow pages, whatever) by taking in account that you will
have to see the person regularly. So not too far from either home or office.
Just pick 3-4 names of the appropriate gender in an area you could easily
reach once a week during workdays.

Set up a meeting with each. Explain your problem, discuss what option you
have.

After the last meeting, review which one gave you the best feeling (assuming
more practical consideration - like the fees - are comparable) and pick
him/her.

------
maxxxxx
I had a big crisis years ago and thought I need professional help. Finding
that help was almost more depressing than the depression I already had. One
thing I have learned is that if you have any doubts about the person you are
working with, keep looking until you find someone you really trust and get
along with. When I looked I was already in a bad situation and had several
disappointments that only took me down even more.

I think there are a lot of not very good mental health professionals out there
and even among the good ones a lot of them won't be a fit for your
personality.

------
mirajshah
If you are in RI, MA, or NY state, the website
[https://www.zencare.co/](https://www.zencare.co/) might work for you. It
comprehensively listed all of the mental health professionals near me that
were on my insurance provider's search portal, with much richer profile
information. I liked it because I could very easily find a professional who
specialized in the types of things that I sought care for and who I would
likely feel comfortable with based on my reading of their background
information.

------
nnash
I used a directory like Psychology Today to find a counselor that ended up
being a great fit for me. He was understanding of my situation (in-between
jobs) and even gave me a discounted rate. Stay strong.

------
amyhorowitz
Several options:

Ask your health insurance company for a list of covered providers.

Seek a referral or recommendation from your primary care provider.

Ask trusted friends or family.

Contact a local or national mental health organization by phone or on the
internet,

~~~
droidist2
> Ask your health insurance company for a list of covered providers.

This was going to be my advice. There's probably a directory on the website,
for instance:
[https://www.aetna.com/dsepublic](https://www.aetna.com/dsepublic)

Call a few of them, see if their specialties match your needs, ask if/when
they have appointments available.

------
baus
I've found in many areas (I've moved around a lot) few Drs and therapists are
accepting new patients.

I wish I could find a psychiatrist who also does psychotherapy. Psychiatrists
are focused on drug maintenance. Finding a good therapist is difficult, and
I've almost given up.

I'm moving to a new area, so I will probably start the search over again. I
wish I could offer more advice, but I think it comes down to just trying out a
few therapists. And make sure they actually listen to you.

------
hellofunk
I don’t have the answer, but I wish to say this is a very excellent question,
because many people think that all therapists or psychiatrists are created
equal, and this is so far from being the reality. Most of the therapists or
psychiatric professionals I’ve encountered or have had family members deal
with, have been, in my experience, quite terrible at what they do. There been
a few shining stars, and the rest probably shouldn’t have been in the field.

------
notduncansmith
2 things from someone who just went through this process.

First: if you pick wrong, you haven’t lost much beyond a little time (less
than you spent depressed) and a few copays. Set an appointment TODAY, and if
it doesn’t work out, pick a different one.

Second, when picking: lots of therapists have a website where they write
something about how they approach things. If it sounds plausible, make the
appointment. You will know after the first session whether you should book a
second one.

------
docker_up
Finding therapists is very, very hard. Not only do they have to be good, but
they also have to mesh with your style. I've gone through this tiresome
process. You need to go in with the attitude that the therapist is going to
suck, and that you will have to go through 20 of them before you find the one
that's right for you. Lowering your expectations and anticipating a long but
ultimately rewarding search is the best way to take it.

------
endlessvoid94
If you live in the SF Bay area, I would recommend using reflect
(joinreflect.com). I believe they have the largest network of mental health
pros in the area.

------
partycoder
Disclaimer: I am not familiar with mental health since I am neither a mental
health professional, enthusiast or patient. Take this opinion with a grain of
salt.

\- get a diagnosed by a professional if you perceive a problem.

\- don't self diagnose. try to make a distinction between facts and opinions
as much as possible.

\- follow treatments responsibly.

\- if the treatment is risky (e.g.: high cost, side effects...), get a second
opinion first, unless it is urgent.

------
jen729w
Random suggestion: outsource it. As in, outsource the decision. I'll pick one
(two, three) for you.

I'm not being facetious. I don't have the indecision paralysis you do because
I'm removed from the situation. So, give me a radius and a budget and let me
help.

Not a scaleable solution, but hey. PM me. And if not (it may well be a
_terrible_ idea), good luck.

Edit: lol. No PM on HN. My email address is in my profile. :-)

------
popnroll
Most of professional therapists are highly empathic, they are not like the
average person. You will never be dissapointed, even if you feel you need
another therapist, the experience is worth.

Don't overthink too much, a therapist is not a friend, your problem is not
strange for them, they deal all the time with people suffering the same
problems you are experiencing.

Good luck.

~~~
penagwin
I'd like to add, it's okay to consider them "a friend" as long as you keep the
context in mind. They're there to help you, so you can rely on them and trust
them. You literally can't disappoint them though, that's their job. Although
they aren't the kind of "friend" you'd hangout with, etc.

------
tptacek
I'm offering this mostly just as a way to put some structure around the
problem you're facing, since I feel like I know where you're coming from with
this problem. The important thing, I think, is to come up with a plan to move
forward even if just a little bit, and then you can iterate. So hopefully this
is helpful.

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.

------
IamNotAtWork
Therapy wasn't for me. I had a hard time opening up myself to complete
strangers. Moreover, you need a lot of sessions to make a difference, which
equates to a ton of money. So for years I have been taking meds, which general
doctors are happy to prescribe.

Recently I got completely off of it. I know my body well enough to know that I
can, so I did. I did it because I was unhappy with how many side effects it
had, while not really making me happier... just more level I suppose. I still
lacked a desire to do things that I used to love while on meds.

I find that two things really shape how well I feel. 1) sleep. Lots of it, and
good quality too. 2) exercise. It helps to have exerted a lot of energy so
that sleep is better. If I haven't exercised for that day sleep will be hard
which makes more more depressed and work less effectively the next day.

Like others have mentioned, you need to find a therapist that clicks with you.

Prioritize your health over your work. Work 8 hours and no more. If project
might get delayed then so be it. Your PM will have to allocate more resources
or fire you. Have enough money saved up so that even if you get fired you
aren't screwed. If your stress isn't caused by work, then something else, but
since you are asking on HN I suppose it is related to work, and the isolation
that it brings.

------
mhkool
Most therapists do not know the root cause of mental diseases. I recently
watched a docuseries about mental diseases by Dr Mark Hyman at
www.brokenbrain.com where some 50 doctors explain various causes of brain
diseases. It is an understatement to say that you will be shocked at the end
of the docuseries. I strongly recommend watching it.

~~~
smolder
The trailer is overflowing with bait akin to "learn more after this commercial
break!!" on the news. That technique generally correlates with nothing of
substance coming later. Is the MH in your username for Mark Hyman?

------
tombert
Honestly, and this is just me, but services like Doctor on Demand or Teladoc
have been incredibly valuable to me. Being able to schedule appointments for
the weekend (or later at night) ensures it doesn't get in the way of work.

I was fortunate enough to get a pretty awesome doctor when I did it, but I
seriously cannot recommend DoD enough.

------
foundatherapist
I found my therapist with
[https://www.findheadway.com/](https://www.findheadway.com/).

Afterward, it also automatically submitted my insurance claim for me, so I
didn't have to do all that paperwork, which I probably would have given up on
anyway.

Unfortunately, it looks like it only works for NYC.

~~~
throwaway-18613
Don't know if this is an ad or not, but this is basically exactly what I'm
looking for. Thank you!

------
Broken_Hippo
First things first, talk to your regular medical doctor about medication. I
could not fathom talking to someone without first having that, partially
because it was so overwhelming.

Outside of this, it really just depends. Religious? Pick one that follows your
religion. Not religious? Start with one connected to the local hospital. Have
a gender preference with friends? Then choose that gender. I'd stick with
folks with psychiatric degrees - a psychologist (therapist) or a psychiatrist.
If you see a psychiatrist, not only can they prescribe medication if you need
it, but they might hook you up with a therapist that can help you best. On the
other hand, if you'd like to try to avoid medication, start with a
psychologist or therapist. Licensed and educated, of course. This just helps
you narrow choices, after which you can pretty much pick at random. The
important part is just to make the appointment.

Tell them upfront you are uncomfortable talking to them. They should be easily
able to deal with it. If you have a few sessions and still feel uncomfortable
talking to them, you can try again using similar criteria.

------
ShabbosGoy
If you have specific mental issues, like depression, you should look into
psychedelic therapy. I’m not sure how many are legal, but would assume they
are if affiliated with some study. Psychedelics can be curative w.r.t
depression and anxiety, as long as you have the right guide/therapist.

------
carapace
Try at least six. Give each one two or three sessions to do _something_ ,
whatever their thing is, and check if it helps at all.

Keep trying people until one really resonates with you and helps you.

Do not pre-judge methods. Go to "woo-woo" people as well as mainstream. Do not
try drugs unless you have already tried at least ten or twelve non-drug folks.
If you've been to twelve different therapists/healers and no one has been able
to really make a dent in your issue(s) then that's a good indication that you
have something more than "just" psychological and you should try drugs in a
responsible manner. Again, don't be afraid to try several things under
supervision of a responsible trained experienced professional. Don't be afraid
to include cannabis if it's legally available in your area.

This comes from personal experience.

Last but not least, a lot of people in the modern space-age-a-go-go era are
suffering from _spiritual_ malaise. What are your deepest values, and are you
living up to them in your daily life? In what or Whom do you have faith?

------
throwaway130718
TLDR: One answer - if you're in a decent-sized city - is to look for people
who have published on the particular issue you're having. My other piece of
advice is : always set a time limit.

This is a difficult issue, for a few reasons. The stigma surrounding mental
health means no-one (to a first order approximation) goes around raving about
the really great therapist they found. This has a couple of consequences.

First, therapists don't specialise. They need to get clients, so they list
themselves as being able to treat every mental health condition on the
professional registers. Hence, look for people who publish.

Second, it's not hard for a mediocre-to-bad therapist to keep going and earn a
living. There are no reputational consequences. Even the best therapists wont'
succeed all the time, some people would recovered anyway, so it's easy for
them to kid themselves that they are better than they are.

The other problem with mental health is that the incentives are backwards.
Mental health professionals are paid by the hour, whether they help or not,
and don't have any incentive to think about whether you would be better off
trying someone else after all this time. And if you are depressed it's hard to
get up the will to think about changing your therapist, so it's easy to let
things drag on in the hope that they eventually work, wasting huge amounts of
money and time. Hence, set a date at which, come what may, you will either
stop or try a different one. Sooner than they want.

------
buildbuildbuild
If price is a primary concern I highly recommend calling an institute which
represents the form of therapy you would like to undertake.

For example, calling the Jungian Institute in NYC and describing your
financial position can place you in quick touch with therapists who operate on
a sliding scale.

------
pronoiac
The Metafilter Wiki has a page about finding help:
[http://mefiwiki.com/wiki/ThereIsHelp#Therapy](http://mefiwiki.com/wiki/ThereIsHelp#Therapy)

I run this wiki, and I'm proud it's a useful resource on this topic.

------
foforito89
There is an app called Doctor On Demand. It’s available through work, and
allows you to see a psychiatrist or psychologist wherever you are. Download
here: [http://bit.ly/workbenefit](http://bit.ly/workbenefit)

------
foforito89
There is an app called Doctor On Demand. It’s available through work, and
allows you to see a psychologist or psychiatrist wherever you are. Download
here: [http://bit.ly/workbenefit](http://bit.ly/workbenefit)

------
bowenarrow
We're a young startup trying to address this exact problem.

www.trysophia.com matches you with a mental health therapist who's well-fit
for your needs (only in Boston, for now).

We're focused on in-person talk therapy that 'clicks'. Eager to hear any
feedback!

------
cgriswald
An easy filter is to reject any professional who does not hold a Ph.D. The
costs are naturally higher, but, this worked well for me. That's not to say
others are not qualified, but the signal-to-noise ratio seemed much higher to
me.

------
alando46
[https://openpathcollective.org/](https://openpathcollective.org/)

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.

------
lkrubner
No one should ever feel bad about seeking help. It's a great sign that you
even want to seek help. Burnout is universal. I wrote about this recently:

" _As I’ve gone through my 30s and 40s, I’ve been surprised at how many of my
friends have suffered some kind of burnout. In fact, between the ages of 15
and 45, I would say that everyone I know personally has had at least one bad
year. Back when I was in school, it seemed like some people were reliably
happy, and other people were reliably depressed. And yes, many of those
personality traits turned out to be consistent over several decades. But it
was a surprise to realize that even the happiest people could fall into a dark
spot. Some people are highly resilient, but no one is infinitely resilient._ "

[http://www.smashcompany.com/philosophy/burnout-is-
universal-...](http://www.smashcompany.com/philosophy/burnout-is-universal-
but-the-right-kind-of-sleep-food-and-exercise-helps)

Also:

" _If you feel you need a therapist, the question then becomes, "How to find
the right therapist?" If you are lucky enough to have the money or good
insurance, I strongly recommend that you go to 3 or 4 different therapists, at
least once, and see if you click with any of them. In some sense, there are no
"generally good therapists" there is only the therapist who is good for you.
One therapist might be great for someone else, but terrible for you. It's a
very unique relationship, and it takes some work to find it. But if you lack
the money or insurance that might provide you with the option to try several
therapists, then another option, not quite as good but cheaper, is to go
online and talk to others who suffer your particular version of burnout, and
ask them if they would recommend someone in your area. Also, if your struggles
overlap with the kinds of struggles that are addressed by any kind of 12 Step
program, then going to the local chapter of that 12 Step program is almost
always going to be your best bet._"

------
roflc0ptic
My partner is a therapist, and she has a video answering this question -
[https://m.youtube.com/watch?v=e1rk8DoeiM0](https://m.youtube.com/watch?v=e1rk8DoeiM0)

------
tecklenburg
Try an online Therapist first if that is easier for you. It goes via chat,
instant messenger, or e-mail. From that you can move on to a face to face
therapy later. And also read books written by Yalom ;)

------
iaskwhy
I've found mine in a therapist directory (for the UK):
[https://www.bacp.co.uk/search/Therapists](https://www.bacp.co.uk/search/Therapists)

I remember I was so nervous and full of doubts about doing it, I had nobody I
trusted I could talk to at the time but I was doing really bad. I first tried
to find a familiar face on that directory, just based on pictures, someone I
could see myself talking to. When I did find someone, it took me a few days
before finally trying to reach them. It was extremely difficult to be honest.
But I did it. It's been a few years now. Couldn't be happier with my decision.

Good luck. And feel free to ping me if you need any help.

------
beenBoutIT
You need to take a top-down approach. Have your GP rule out physical problems
that can easily be identified objectively and cured before you delve into the
subjective realm of mental health where there are no cures. Rule out
hypothyroidism, diabetes, chronic fatigue, brain tumors, heavy metals, etc.
before you entertain the idea that you have mental health problems. If you
determine that you have a clean bill of physical health, find a clinical trial
in your area(clinicaltrials.gov) where they're treating depression with
psychedelics and get your GP to diagnose you with whatever that study requires
for admission.

------
vinceguidry
One of the best things I've ever done was to find a coffee shop to frequent.
I've made many very very good friends there. One of them was a psychologist.
Last year when I decided to get some therapy of my own, I asked her for a
referral.

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.

------
brandoncordell
I found a psychiatrist on HealthGrades. Saturday is my third appointment.

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

Stay strong.

------
pg_bot
Contact your insurance provider to get a list of doctors that are in your
network. Otherwise it is word of mouth and research.

------
will_pseudonym
Finding a good therapist is similar to find someone to date. Their
qualifications should be good, but you need to find someone you mesh with
personally. If you can't imagine hanging out with that person outside, you
aren't going to have a good time, in my experience. You will likely have to
try a few therapists before you find one you click with.

------
fiveoak
Not sure if your insurance has it, but my health insurance has a website where
I can login to it to view my EOBs/etc and also has a section to lookup doctors
in the area that accept my insurance.

Either way, sending positive thoughts your way and hope you can find someone
helpful :(. Struggling with mental health can be a profoundly shitty time.

------
s-shellfish
Does your insurance have a search for doctors?

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.

------
schmeddie
I went through this search earlier in the year (been think about it for YEARS,
best thing I ever did). Here's what my search looked like:

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...](https://art19.com/shows/the-ezra-klein-
show/episodes/805c9dc7-ce7d-4238-9e1b-491f138e61e4)

------
cozzyd
Your local NAMI chapter may have people who can help you find someone.

------
dsego
Most shrinks I've had experience with act like pez-dispensers for your typical
SSRIs and benzos. They listen for half an hour and then change the dosage a
bit. I would do a psychological evaluation and look for someone with
experience in CBT.

------
mabynogy
Ask people you already trust (like your doctor).

------
crb002
Give Jim a call, one of the best in the business. [http://www.cie-
ankeny.com/contact](http://www.cie-ankeny.com/contact)

------
aridiculous
This is a tough problem! Writing this to address your concerns but also for
the comment readers. I don't provide great solutions, but I think validating
your problems is helpful and hope there's something useful in here:

I've been thinking for a while now that we need people you go to help you find
a proper therapist. Like a consultant/dispatcher/human load-balancer/Mental
Health GP. Medical GP's have no idea what they're talking about in this
department (save some outliers) and would probably admit to that if pressed.

The approaches as they stand now aren't ideal, so I feel your frustration:

1) Pick one that accepts your insurance located near you: Those lists that the
insurance companies publish aren't up to date and Psychology Today is also
dicey. And you're right, they all start to look the same (they are most
definitely NOT in reality). Many mislead by saying they accept insurance but
really mean out-of-network benefits, which typically aren't great especially
if you're not working for a mega-corp. There's also a sizable body of
therapists who will charge high rates (not in proportion to quality) because
some rich clients won't care. It's a bit dirty to me, but a lot of the time
they'll reduce their rate very quickly and dramatically once they know you're
not rolling in hereditary wealth. For example, I've seen $350/hr off the bat
reduced to $100/hr with one simple statement of "that's outside my budget".

2) Pick by approach: In theory is a good way to start, because some modalities
probably aren't a good fit for certain classes of problems and personalities.
However, it's a tough balancing act. A therapist who is too focused on one
modality is probably a bit inexperienced, because they're in everything needs
a hammer mode. However, listing too many modalities sometimes indicates a lack
of rigor, focus, point of view.

3) Sites like Therapick are great in theory in that you get a video
introduction to assess someone who might be a good fit. However, they tend to
attract less experienced therapists (who could be good!) who are trying to
build up their client-base. Just like rent-stabilized apartments in New York
City, you're less likely to see the most experienced and popular therapists
doing active recruitment like this because they're snatched up quickly and
don't need to spend the time and effort.

4) I would highly discourage any of those phone/texting therapy services. Who
knows, they may work for some, but they don't strike me as plausible solutions
for most, if not all, people. If it's money that's a concern you're trying to
solve for (which it usually is to some degree), there are other approaches to
solving that. If time and convenience is a concern, you really need to get
reevaluate what you think therapy is. To me, these services are bandaids,
which I suppose have their utility.

5) Recommendation through another therapist: This can work, but you should be
aware that therapists form milieus — talented ones tend to hang out and
consult with talented ones, and vice versa. So if you have a bad therapist,
it's likely their reference is as well. My personal, albeit possibly
offensive, theory is that there's small pool of truly gifted therapists (less
than 20%). I subscribe less to the notion that there's a perfect match
therapist for everyone and that it's just a matter or style and personality.

On top of all this is what I called the Fundamental Therapy Problem in that
it's quite possible you shouldn't be the one deciding what style would be best
for your long-term interests. Don't think too hard about this one, because
it'll drive you nuts :) But it helps to try to assess based on gut feelings of
feeling secure and feeling challenged, rather than a heady, logical
assessment.

At the end of the day, it's common knowledge (and backed by some studies) that
it's really about the relationship between the people. If you feel
intimidated, baffled, weirded out, or annoyed consistently — or if you don't
truly respect your therapist — it simply won't work. Don't waste your time
hoping to get used to it, it won't get better.

In your situation, I'd recommend a strategy of finding a good-enough therapist
to start. But there'll be a point where it'd really help to find an excellent
one. That will be easier once you've leveled out a bit.

In conclusion, references are the best from friends you trust (hard to get
sometimes because of privacy concerns), and then a scattershot (guess and
check) approach. Expect it to be a bit of an expenditure when you're
interviewing around at the beginning. But have faith, things can get better
rather quickly once you have a decent therapist situation established.

------
forapurpose
I had to find a therapist for someone I know who was unable to do it for
themselves. It's difficult; even referrals are hard because, as one therapist
explained to me, therapists don't ever see each other practicing their craft
and what they do is confidential.

A quick answer: First, expect to shop around; odds are against the first one
being a good fit, but be patient - a good fit is out there. Ask the HR
departments at your employer or at large companies; tell them your difficulty
in finding a therapist and I'd expect they would be happy to help - it's free
and easy for them. Their referrals may charge high rates but hopefully they've
been vetted by the feedback of numerous employees (though of course those
therapists might also serve HR priorities - HR may prefer one visit for
medications to a year of talk therapy).

Longer answer:

I looked into it, doing research and talking to numerous therapists. Here's
what I understand:

* It's the singer not the song. A widely accepted belief (I don't know how widely, but more than one professional confirmed it and I've seen research[0]) is that success depends much more on the therapist than on their technique. Also, good therapists have a variety of tools that they adapt to you. IMHO if they are selling their technique ('as seen in my seminar / published in my book!'), that's a bad sign.

* Rapport between you and the therapist is most important. If it's not there, move on. You need to feel comfortable and trust them enough that you can be completely open, even about the things you don't admit to yourself, and to not feel threatened when they say things that hit a nerve.

* Characteristics of a good therapist (leading to good rapport): 1) Empathy, 2) Positive regard (toward you), and 3) Congruence (the therapist's congruence with their own emotions)

* Characteristics of a successful patient: 1) Feel safe with the therapist; 2) Trust the therapist; 3) Ready for real change.

* Find someone with experience treating your problems. As you don't have a diagnosis, that can be tricky, but a trial session with a few therapists can give you direction.

Finally, I found this to be very helpful and showed it to a professional who
said it was valid:

[https://web.archive.org/web/20161102164453/http://thomastber...](https://web.archive.org/web/20161102164453/http://thomastberry.com/the-
ideal-therapist-and-the-troublesome-client-dr-melfi-and-tony-soprano/)

Good luck! I hope that's helpful.

[0] Some research is discussed here in the article linked above.

------
ondoheer
I am a psychotherapist as well as a developer, I'll share some of the things
we mental health professionals think or suggest. Some of them have already
been said here, but I thought summarising my own thoughts on the subject might
help.

1) There is no magic formula. Most schools of therapy believe a sincere
relationship between patient and therapist has to develop for it it work
great. Therapist casting is a great suggestion, and as someone else said, if
the therapist isn't comfortable with that, maybe he isn't the right fit.

2) I have studied and trained in different schools of therapy, mostly because
I noticed quickly, how certain schools work better for some patients as well
as for some therapists. Many times we are limited to what we are introduced to
in school, masters or therapy school. It's like working with different
programming paradigms, some people view of the world or way of thinking work
better for some paradigms that others. We can all adapt, and learn how to work
in a particular frame of mind.

Certain people fit better into a therapy style/school/paradigm. Certain
pathologies, illnesses, problems get better results with certain techniques.

I would recommend, also asking the therapists what school / type of therapy
they work with, and how would they approach your case.

The first thing I always do before recommending a therapist is get to to know
the person asking a little better, then about their problem and expectations.
This helps to shrink the list of possible therapists.

3) Ask the therapists if they supervise their cases and if they have gone to
therapy themselves.

This is vital. The good therapists know our mind and emotions are our tools of
the trade. We have to able to differentiate if what we are feeling/thinking in
therapy is a miss interpretation we might be having because of our own issues,
or if it is a correct interpretation of what is happening to our patient.

The only way to achieve this, is with our own therapy and continuous
supervision. Therapy allows us to work on our own issues, be aware of them and
recognise them when they pop up.

Supervision allows us to have other experts help in noticing our blind spots
when working with each case.

A therapist that doesn't supervise, will get stuck in some therapy patterns
and have a harder time noticing your particularities.

A therapist that hasn't been to therapy, might be to blind to many things,
feels above their patients and won't really connect with you.

Most good therapists I know have been to at least 2 different therapy
processes along the years (lasting several years each).

4) We always recommend the therapist as a person. I don't just recommend
people from a technical/training perspective, I recommend the person, because
in the end, a therapists - patient relationship is that, a relationship
between two people. The therapist values, perspective on life, and life
experience, will pour into the therapy, no matter how much supervision and
therapy we get.

I hope this helps.

------
ljm
You've managed the first step, which is coming to the awareness that you're
dealing with something and need some professional help.

I won't claim this to be a recommended way, it's only what has worked for me.
I first sought therapy through the system (well, the NHS because I was in the
UK...'the system' sounds ominous), but grew to feel that they weren't equipped
to address my particular needs. It was useful but professionals working within
these institutions often lack the flexibility to explore alternative
processes.

Since that time (around 9 years ago) I switched to seeking recommendations for
local psychotherapists; professionals who were qualified to work on the level
of meditation, somatic healing, and other things you're not likely to get from
a GP appointed therapist or counsellor. Most cities will have directories for
such therapists and, as is normal, you'll get the chance to have an initial
consultation call to understand whether that's actually the right approach for
you. A responsible practitioner will say no if they don't think it will work,
and may well offer recommendations for something more suitable.

It might be that you do a few sessions and realise that you need to touch on
something else, and maybe you need someone else for it. Or you don't feel a
rapport so you're not making progress. This is all fine, it's important that
you allow for some trial and error so that you can establish a relationship
that supports you and works for you.

The most important thing is to use this initial spurt of courage to reach out
to someone and get the ball rolling, even if you don't commit to them. It's so
easy to overthink it and take a perfectionist approach, where you have to
intuitively know that you either need a life coach or a psychiatrist or
someone else, and eventually the inertia will itself become a blockage and a
contributor to your burning out. It is overwhelming, I know, because you don't
know who you can trust.

On that level, what I would suggest is to reflect on your circumstances. A
therapist (of any kind) is going to be with you to explore your past and work
through issues there. A life coach is going to be with you to explore your
future.

After all of that, if you have a close friend or a partner you can trust
implicitly, try reaching out to them by asking if they'll hear you out. The
idea here isn't to let them shoulder your burden, it will just push them away.
Instead, it's to know that you've got someone who wants to be there for you,
and is happy for you to open up to them, while allowing yourself to
reciprocate should they need a confidante in you. This can work wonders while
also using therapy to work through what you're going through.

I don't know how any of this applies to going through insurance, and it
doesn't offer any concrete answers, but unfortunately we're not dealing with
taking a broken leg to the nearest hospital.

And to re-iterate some other points: don't commit yourself to the idea that
therapy will 'fix' you or you'll get some immediate result. It might be that
you need something else and you're not quite aware of it yet. To that extent,
I wouldn't recommend jumping onto the spiritual path with meditation and all
of that unless you feel your own calling to it and are confident in yourself
about what you're opening up to. There are plenty of snake-oil salesmen out
there who will take advantage of your current vulnerability and try to rope
you into something that will do a great deal of damage over time.

------
delbel
Be careful, try to figure it out yourself first. There was a disturbing
experiment called Rosenhan experiment. Research Cognitive Behavior Therapy and
try a good faith effort and commitment to review all of the material and
exercises, if you can, before seeing an "expert"

~~~
kec
In the Rosenhan experiment, the subjects faked the symptoms of psychosis until
they were involuntarily committed. If you fake symptoms for an illness you
can't be surprised that doctors assume you have that illness.

This is a far cry away from seeking a professional's opinion in good faith.
Telling people to avoid help citing Rosenhan is extremely irresponsible.

~~~
limeblack
I agree the Rosenhan experiment is rather silly, but if you look at the
placebo medication vs actual medication studies it does make you question the
long term effectiveness of the drugs.

There is more recent study done in 2007 with the same results but I can't find
it right now.

This is the 1967 one. Antipychotics really haven't changed as much as most
people suggest.

This NIMH study looked at one-year outcomes for 299 patients who had been
treated either with neuroleptics or placebo upon their admission to a
hospital, and was the first long-term study conducted by the NIMH. The
researchers found that "patients who received placebo treatment in the drug
study were less likely to be rehospitalized than those who received any of the
three active phenothiazines (thioridazine (Mellaril), fluphenazine (Prolixin),
chlorpromazine (Thorazine)." However, in spite of this finding, which the
researchers wrote "was so unexpected," the NIMH investigators stated that they
"were unprepared to recommend placebo as treatment of choice." In other words,
the NIMH researchers decided they wouldn't develop treatment guidelines based
on their own research, which found that placebo patients did better than the
drug-treated patients. SEE PAGE 991.

[http://psychrights.org/research/digest/chronicity/comunityad...](http://psychrights.org/research/digest/chronicity/comunityadjustment.pdf)

~~~
delbel
I don't know how those research findings got out. Somebody at the Ministry of
Truth screwed up. Remember to take your Soma, and be well.

------
csomar
I suggest you don't. Went through that route by going through several mental
health specialists and doctors. I have also seen others close to me go that
route too.

My advice: Avoid that route like a plague.

The short story is: Their incentive is the complete opposite of yours. They
make money from your misery, and continued depression. They are not
incentivized to make you better as that will mean less money for them.

Lots of psychiatrists make money from big pharma sponsoring. Their job is to
prescribe as many medicines as possible. It is a hell-circle then. The meds
keep you in a "cool" state but not productive/social. After a while your
consciousness start to realize how bad your situation actually is. The doctors
remedy to that is to give you more medicines and stronger doses.

How I did it? You are the best person to cure yourself. Once you are very
close to suicide, you realize that nothing matters. So be courageous to make
life changing decisions. It'd help if you have the cash to finance such
decisions.

Good luck. If you are done and in doubt, take a plane ticket to a 15h far
country.

~~~
sigotirandolas
I feel that there is some truth in your comment, but that the conclusion is
completely wrong.

You're right that there are some incentives for therapists (or "fake
therapists") not to help you, or at least not to help you enough. In fact,
there's a big market of scams in this area. But a big part of the market is
not there to scam you, either because of morals / good faith, or because of
counterincentives (rating systems, social proof, building trust with the
patients, recommendations, competition, etc.). You could also argue that many
other businesses such as language schools have incentives to keep you around
forever, and certainly many lengthen the process, but the system mostly works.

Almost the same can be said from psychiatrists: They certainly have some
incentives for keeping you around forever or scamming you, but they also have
the same counter-incentives. For example, psych meds are also widely
prescribed in countries where healthcare is not as much money-based as in the
US.

And additionally, there's ample easily-accessible scientific literature on
antidepressants online done by both sponsored and non-sponsored scientists.
SSRIs suck, and for a lot of people they do nothing useful or are even
counterproductive, but there's actually nothing that is qualitatively better
than SSRIs for most depressed/anxious people.

Finally, recommending inaction until you reach rock bottom (where there will
supposedly be a surge in motivation that will make you fix your life) is very
reckless advice. First, because at rock bottom a lot of people will be more
motivated to suicide rather than take productive steps. Second, because many
people will not actually reach rock bottom, but rather stay in sustainable
misery indefinitely. Third, because while depression/anxiety have many
environmental factors, they are not solely environmental, so for a lot of
people even completely replacing the environment will not help much. Case in
point: I went from living with my parents, to living on my own on a city 1h
away and earning a living by myself. It certainly helped with life skills and
confidence, but the core mental problem was still here.

------
z3t4
If you want to feel more depressed - go to a psychologist. If you want to get
a mental disorder - go see a Psychiatrist. If you think you need to see one of
those you are not sick enough. Instead you want to go to a executive coach, or
someone who practices positive psychology. But if you are talking to aliens on
a daily bases, or think it's perfectly normal to wash your hands ten times in
a row, then go see a therapist. When you get into a mental hospital, the first
thing they do is to fix your daily routines. So if you are feeling mentally
ill, fix your daily routines! Wake up at the same time, go to work the same
time, and very importantly - go home from work the same time, eat the same
time, and go to bed the same time ever day. I have never felt this good since
I got my routines fixed. I long to get to work every day I wake up. And I have
my wife to thank for a lot of it, if I'm five minutes late from work it feels
like she'll kill me. I used to work 12 hour days and sometimes whole nights
before I met her. But I'm more productive now ! I can no longer finish a
project over a weekend (with no sleep), but I get consistent progress _every
day_ several months in a row.

