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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.

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.

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.

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

Completely agree with this, and will even say that the weird thing about mental health is that you may not even be able to trust your own judgment, since that's the part thats sick.

A few years ago, I had decided on my own that I needed medication; the depression was so overwhelming that I felt like the problem had to be chemical, and no "touchy-feely" talking therapy could possibly help. I went to a few psychiatrists, with varying degrees of success (I caught one reading side effects of a medication off of wikipedia) and stopped going several times because I felt like it wasnt helping. It was only when things got bad that I found a therapist (I think I just googled "therapist <my neighborhood>") -- who I liked -- and she convinced me to just give her way a try. It worked.

I am on medication again, and its helping, but it was really the therapy that I was so against thats making the biggest difference. All of this is to say that find someone you like, and then be open. Deciding how you want to be treated from the outset doesn't necessarily make sense. Mental health issues are like any other illness -- we go to doctors for their advice and expertise. But you need to go.

Want to strongly re-affirm the fact that you should tell them you're exploring multiple therapists, and that you SHOULD try a few. Each therapist has a different style, and therapy is not a formula that everyone just "implements". Being able to form a connection with your therapist is very important, and while you might pick the right one off the bat, trying a few will help you pick the right one for you.

This is absolutely true, as a therapist myself, I always recommend this.

Of course. The trouble is finding those first few people to talk to in the first place.


I'm really not kidding. The range of usefulness of therapists is so large that "any therapist is a good starting point" usually works. It's better when you can ask friends, but if you can't, any therapist will do.

I work in the mental health space (we make practice management systems for therapists) and I couldn’t disagree more. The quality of therapists varies so widely that frankly some of them, I can’t imagine how they ever got licensed.

Working in the industry, would you have any specific suggestions for someone who feels overwhelmed to winnow the options from 1000-ish to under a dozen?

As a person who recently had to do this, my suggestion would be to find someone close to either your home or work. Next would be to find someone of the gender you prefer (I prefer same-sex), then find someone in the age group you're in. I've had good luck using this heuristic to whittle down the list to a few names.

Then go for a brief session with each of them. You should pick the person you feel most comfortable talking to EASILY. This person should be someone you don't feel judged or threatened by. You should be able to understand them clearly and they you.

Think about it like it's a date. In a way, it kinda is.

Indeed, you both have to click, as a therapist, I won't receive anyone I feel I couldn't work with sincerely (no judging and lovingly). In those cases I would always recommend someone I feel would be better suited.

I'm saying the same thing. I'm also saying that without a personal referral, you can't tell. (Hence my upstream recommendation of having a trial session and asking for referrals)

But outside of "pick one and start there", what would you recommend if somebody can't get a recommendation from friends/family? How do you find a decent practitioner?

It’s even a rare glimpse of motivational catalysis that a depressed person can muster up the activation energy to reach out for help and assistance. Agree with you that these steps often cause the person to lose that fleeting motivation.

Fwiw I’m fortunate that many friends are open with me that they are/have been seeing s professional. So I would go to them for a referral. As one good friend put it, “we get help for our bodies, so why not our minds?”

The best website that I've found that begins to fit this is Zencare. Entered what I was looking for, got a group of practitioners that have videos available so I get a bit of a feel for them, and I scheduled a phone consultation immediately through the website. Its currently regionally limited (RI, MA and NY) unfortunately.

I've since moved out of the area though and have been trying to find a replacement and its been such a painful experience.

Thank you for this suggestion. It's the closest I've seen to far to a solution. A sad shortage of providers who take my insurance, but the UI made it otherwise easy to narrow down to a manageable number of options.

> This is something that needs to be solved with an online questionnaire that spits out an appointment time and location at the end.

My brother just got some (charitable) funding to develop an app to do exactly this! Very early stages of the project so it's hard to say how well it will go but his hope is to solve exactly the problem you're talking about. (I might be helping to develop the app, depending on scheduling.)

As a therapist and developer myself, I would love to see what this is about. Ping me if it is posible.

Only just saw this! Feel free to email me at the email address mentioned on the webpage that my profile links to and I'll get back to you. (I don't really check the email address mentioned on my profile itself.)

This is a fantastic insight, and I hope someone approaches YC with it. A UX where you basically press a large red button and end up with professional psychiatric care would save lives.

My little company built such a thing but YC and others like them are very disinterested; it’s very hard to get traction for something like that because you are looking at millions of dollars in marketing before there is enough of a network effect to become useful.

And is also a very subjective market. A great therapist might be the worst for someone. I know of a few initiatives like this in Spain a few years ago, and the review/recommendations system always felt clunky.

Besides, some schools of therapy would think the expectations of a patient that expects you deliver a 5/5 stars therapy, would taint the natural therapy process.

Yes, exactly. I wish I could pop my location and insurance plan into a website, and get back a list of 3 nearby providers who are accepting new patients - even better, links to a site where one can schedule appointsments with each of them.

Google, however, is prohibitive. You end up having to either comb through thousands of individual results to find ones that are nearby and take your insurance, or you end up on an aggregator site with literally thousands (at least in NYC) of matches and the same problem with slightly more structured data.

It's just so daunting to make any decision when faced with too much data and insufficient information on how to use that data, that the depressive brain just kind of shuts down and says "fuck it, I can't deal with this now."

Not sure if you are in the US, but Zocdoc does exactly that thing. Enter location, doctor type and insurance, it will show you the list of all doctors/therapists and you can even sort by rating and availability.

You should check the website of your insurance company. Many of them offer exactly this sort of tool.

Mine just offers a data dump of 500 providers and their phone numbers, unfortunately.

Hmm. That's... sort of useful, you could probably script something interesting with that.

I wish. (I'm imagining a filtering system that either prevents you from seeing providers not on your insurance, or flags them appropriately)

I think its important to take any action, make an appointment with ANY doctor, don't stop yourself because it might be the wrong one.

I researched bio's for months before making an appointment. I picked the one person in Vegas that had the experience I was looking for with "Mindfulness Techniques, Neurofeedback, Transcranial Magnetic Stimulation"....

Even though that was what he was expert at, he let me know that those services were not what I needed at that point. After getting actual medications to stabilize, I was in a much better position to try the more hippy-esque treatments and go from ok to happy.

So really trust doctors to get you where you need to go... especially if they have good reviews on ZocDoc (Damnit... I'm doing it again).

> Mindfulness Techniques, Neurofeedback,


> Transcranial Magnetic Stimulation

yeah because a treatment that might induce a seizure is just what one needs.

People, do research and be extremely wary of anything hyped.

For me, dance movement therapy worked. It's not trendy, it takes time and effort but -- it was worth it.

TCMS has some evidence. Here's the president of the Royal College of Psychiatry mentioning it: https://twitter.com/wendyburn/status/986529464422227968




In that first tweet she's talking about English NHS Mental Health Trusts.

Here's the guidance from NICE: https://www.nice.org.uk/guidance/ipg542

NICE don't seem to have anything for "Dance Movement Therapy".

> yeah because a treatment that might induce a seizure is just what one needs.

For some patients, a treatment that does exactly induce a seizure (i.e. ECT) is what they need. Of course, because of the risk of harm, it's still reserved as something of a last resort and only for particularly severe cases.

I'm pretty sure rTMS has nowhere near the same risk profile, even in the reported cases where seizure did occur.

> do research and be extremely wary of anything hyped

I would offer the same advice for anything that is hyped against with scare tactics, if not just, more broadly, any proposed medical treatment.

This is something I'm trying to solve, starting with Australia.[0] I'm building the service that I wish existed when I needed a mental health professional, something I can send friends and colleagues to.

It does a lot of what you suggest. I've started from a position of "so you know you want a psychologist" because otherwise the scope is just overwhelming.

Like people have found, fit is the most difficult thing. I think we can improve this with data. But until someone's figured it out, I recommend always calling a therapist on the phone and talking to them a bit, before committing to a session. The phone is scary, but a bad intro call is much less draining and expensive than a bad session.

We're working on enabling online appointment scheduling for the reasons you say, but getting a uniform booking interface for thousands of individual psychologists turns out to be a huge task.

If people wanted to have a look around we have a test link [1] so the human clinical staff know that you don't need help.

[0] https://mindfit.org.au [1] https://mindfit.org.au/demo

I'm piggybacking on your comment to ask whether anyone has tried any of the remote counseling/therapy services available. There are several (Betterment, Modern Therapy, etc), the prices are transparent (though not cheap), and it's easy to schedule an appointment and pay despite insurance not being accepted for most.

Does anyone actually have any experience with these services, and were they effective?

No, don't do online therapy. For one, it costs the same as in person. But most importantly, the way a good therapist works is by reflecting and empathizing with you. And this is only effective when you are in a room together, their focus is on you, you don't have distractions, and you see their face and hear their voice. The content of their words is secondary. It's all about developing a human connection and opening up.

Even the process of getting up, driving to their office, writing the check, the fact that you have to be on time and have only this one window of time to talk, it all matters because it's a series of tangible steps you're completing for your own self improvement. The computer elides all of this in the name of "convenience"

> But most importantly, the way a good therapist works is by reflecting and empathizing with you.

In my very humble opinion this is the way a bad therapist works.

I've gone to therapy to deal with real problems - attention issues, a bout of anxiety - and having somebody mostly repeat back to me what I said was so, so unhelpful.

Those are more physiological or psychiatric issues that meds can usually solve.

> real problems

Do you hear what you just said?


I don't have any experience with them, so I can't say for sure, but I personally believe much of the benefit comes from seeing someone in person. I can't fully describe why, but I think it has to do with the bandwidth needed to convey mental health issues. That being said, I think any therapy is better than no therapy, so if the choice is between a remote service or nothing, pick the remote service.

Got an opinion based on zero experience and can't explain it but you'll guess anyway? Two can play that game:

I guess that phone and videochat have the necessary "bandwidth" to convey mental issues. After all, people talk for hours via phone or videochat about their lives and problems. And the availability and convenience these media enable helps address the ancestor comment about the difficulty of seeking treatment.

You could be right! And I could be wrong! I was simply thinking out loud.

Do you mean BetterHelp? Betterment is an investing/retirement service.

Oops, yes, I do mean BetterHelp.

I'm on mediCal so I get pretty much one option for mental health, these 'family clinics' and goddamn they are horrible. I've been in one of the deepest depressive swings I've ever dealt with and they really couldn't give less of a shit, but I can't see a normal doctor without paying out of pocket. It's kafka-esque, really.

If you have the need to talk to someone, you can find low cost Therapists.

They are usually students, but I found they were better than the licensed MFCC, and PhDs. The sessions are recorded, and listened to by a licensed therapist.

I believe most medi-cal doctors will prescribe antidepressants. Yes--the medi-Cal system is not great. The drug formulary is workable though. There are some very good medi-cal doctors though. They don't have the much time with the patients, but if you go in with depressive symptoms they will prescribe. A nurse might give you a depression screening. They never worked for myself, but I was told I'm not really depressed. And as my doctor always said, "All my patients are different."

The average medi-cal doctor writes prescriptions for psychotropic drugs daily.

Hang in there. I don't know your age, but the twenties/thirties are a bitch. Just a cluster puck of hormones, expectations, etc.

Don't let this society drive you nuts. The economy is suspose to be blissful. I don't see it. I just see the wealthy getting ahead. I notice so many very unhappy people. We are at a weird time in history?

If I had a do-over, I don't think I would have tried so many anti-depressants. I fell for the advertising. But--but, I'm no Psychiatrist.

Oh yea, too much alcohol can make depressive symptoms worse. I'm not preaching, but I know first hand.

(A bit off topic, but sometimes not having great insurance is not a bad thing in the long run. I have met a few people with good insurance that are vastly overmedicated.)

Isn't the conclusion here that "mindfulness" is ill defined rather than "just run"? Mindfulness in its most serious form seems to basically be a form of CBT, which may have its own criticisms but at least isn't total snake oil. I don't know about you, but I'm rarely focused on a CBT style practice when running or doing yoga -- they seem to be very different kinds of activity.

IMO, your GP is the place to start.

If you say "I'm struggling with X, what is the right type of provider for me", you'll probably have a productive conversation.

Not in the US's healthcare system as it is now. Good luck with that idea.

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