Someone close to me is basically on the edge of a breakdown. She’s under a lot of stress due to both work and family matters, on top of depression issues that she’s always wrestled with. And the election results didn’t help either. She will literally start crying in mid-sentence.
She needs therapy, and probably drugs too. She lives locally, and all her primary doc told her was that there was nobody suitable in our semi-rural county, and to see who she could find in the next county over, which is more urban. But the doc wouldn’t give her any names.
So is there any better approach to recommend to her than just going through the phone book?
Do you really want someone whose approach is to meticulously examine your entire past for months or years before moving forward with what’s troubling you? Because that’s PA in a nutshell.
A psychiatrist is a specialist MD, may prescribe drugs if appropriate. Often a GP will be willing to prescribe antidepressants without a referral to a psychiatrist for specialist diagnosis. But with a serious mental condition, this should always be the first stop.
A psychotherapist provides “talking cure” (non-drug) treatment. It’s a catch-all term, but in principle psychotherapy is based on actual science (psychology), and it includes evidence-based treatments such as cognitive therapy. A psychiatrist will often make a referral to a good psychotherapist appropriate to the condition.
A psychoanalyst follows principles first invented by Freud. Psychoanalysis tends to be expensive and drawn out, and if it doesn’t work the solution is always to do more. Freud’s theories were not scientific, and there is little empirical evidence that psychoanalysis is effective.
I have no personal experience of this in the US, but if your friends condition does not warrant immediate psychiatric help, google “find a psychotherapist” and you will find sites such as this that may give you some leads:
If she’s at all religious some Churches have affordable local counselors they can recommend. As a side note I’m not religious myself, but if she is I have found people in stressful situations often find a great deal of comfort in being part of a church community and there are lots of flavors to choose from.
She may not have the mental energy to find a counselor. If you could do the groundwork for her, that would be a BIG help!
First find out what insurance she has.
Next look in the phone directory for psychologists (best), or counselors.
You can also try your local county mental health department or your neighboring county health department / mental health department.
Then call and tell them what insurance your friend has, ask if and when your friend could see a psychologist or someone who can her. Ask what you can do to help, etc.
Thanks for the clarification on terminology, Riemann. And the links.
Yeah, I don’t know whether my friend should start with a psychotherapist and get a referral to a psychiatrist, or vice versa. I’ll pass those links on to her. I know she had a psychiatrist once upon a time when she lived in another state; I think she still gets depression meds through her primary doc. Not sure if she’s spent any time with a psychotherapist.
I hear tell that psychiatrists don’t just prescribe drugs, but also offer nonpharmacologic approaches. And one can look them up through online rating sites like healthgrades* and even check their names on state medical board sites to see if there are any complaints.
*a disadvantage to these (especially if there are relatively few ratings) is that they can be improperly influenced by inaccurate positive or negative reviews. It wouldn’t surprise me if this problem was more acute with shrinkologists.
To add, for clarity: a psychiatrist will also be trained in psychotherapy. Obviously, psychiatrists diagnose patients by talking to them. However, as MD specialists, psychiatrists are expensive. A common way to manage serious depression or anxiety is to come under the overall care of a psychiatrist, who prescribes and titrates medication; the patient will see the psychiatrist relatively infrequently once a treatment plan and effective medication are in place. The patient supplements medication with regular (perhaps weekly) talking therapy with a (non-MD) psychotherapist of some flavor, who will be much cheaper than the psychiatrist.
Under less serious circumstances, a psychiatrist may not need to be involved. Check with the insurance company, too. They may offer assistance with finding appropriate care.
I’d say sensible approaches are
insurance company for advice;
push the GP for a referral to a psychiatrist if serious;
try to find a good psychotherapist directly, a qualified psychotherapist can also judge if a situation is serious enough to warrant immediate psychiatric care
I’ve had a psychiatrist as my psychotherapist before, but it’s fairly unusual. Most psychiatrists focus on medication management and things that actually require an MD. A psychotherapist may be a psychologist, a social worker, a counselor/therapist, or hold some other credential that will vary by state and the practitioner’s education and scope of practice. Psychologists also do psychological testing and evaluation in addition to therapy; that’s probably not something you need to worry about and you can always get referred if your friend needs a clinical test to diagnose a specific condition. I mention it mostly because it’s the primary difference between a psychologist and someone with a different title that allows them to practice psychotherapy but not to administer psych tests.
I would start by looking at the insurance website, assuming your friend has some form of insurance. If not, or if her insurance doesn’t cover mental health adequately, there should be a county mental health service agency that can provide low-cost sliding-scale services and/or refer to someone who does. Unfortunately, availability is often the limiting factor, especially if your friend is someone who works conventional hours and can’t get off during the day for a weekly appointment.
I’ve been through this recently. A friend referred me to someone she knew who wasn’t taking new clients. That person suggested using the insurance website and offered to tell me anything she knew about whoever turned out to be available. I called everyone on the list in the rather small town I’m in and got several calls back. One was a woman who suggested her husband to me, whom I hadn’t called because he was listed in the next small town over. Her husband is a psychologist, which made sense for me, since evaluation for adult ADHD is one of the primary things I was looking for. The counselor my friend referred me to didn’t know anything about him, but we connected well on the phone and he seemed very committed to figuring out what is causing my symptoms, and he was willing to see me on the weekend or in the evening, which no one else (besides his wife) was. (Oddly enough, the woman who referred me to her husband is herself a psychologist, but she doesn’t do psych testing in her private practice, and her husband does.)
My beef with psychiatry is the tendency for psychiatrists to just throw the kitchen sink, psychopharmaceutically speaking, at the patient and hope something works. But then, even if the patient does improve, there’s no way to know which drug(s) is responsible for which effect. This is true on the flip side, as well. If you’re having negative reactions, it’s exceedinfgly difficult to discern which of the cocktails of drugs is responsible for the negative effects.
I found my psychotherapist directly just by looking through my insurer’s directory of network providers. We hit it off pretty well from the very beginning, but if this hadn’t happened, I would have asked her for referrel. She did refer me to a few psychiatrists once I got up my courage to take medication. She even got me into one doc’s appointment book even though he wasn’t taking any new patients.
If you need to get into somebody quickly, then randomly calling people is not a good solution. The first thing to do is to look at her insurance card. There is often a number for “mental health services” or “behavioral services”. Call that numbner and you will be able to get a list of therapists who participate with her insurance and they may be able to help her get a visit. Start with a therapist who will often work with a psychiatrist for mdication. As noted above, her primary care MD may also be able to prescribe medications.
The thread is a bit old, but it should be kept in mind that you pretty much cannot make an appointment with any form of mental health professional for someone else. You can connect them, you can even dial for them, but you cannot actually make the appt for them. I guess it is too much like involuntary commitment or something.