Questions about therapy

The idea of therapy is something I’ve toyed with on and off for quite some time. I did a quick search and found this thread which while incredibly helpful, doesn’t fully answer a lot of my questions. A lot of what the OP states resonates with me, as I’m a bit wary of therapy in general, but I understand that a lot of what I know about therapy are just misconceptions. I’m curious to hear from those of you in the know. I’ve just got a few questions, hopefully someone can provide some helpful information. Some of these questions may make me seem like an incredible doofus, but I really don’t know jack about how the whole system works, so please cut me some slack!

I’m not even entirely certain that therapy will be helpful for me, as I can’t even decide if I have a problem (which in and of itself may be a problem, but I digress.) Is there anywhere with information regarding pre-therapy FAQs or somesuch that might help me make an informed choice about pursuing this as an option?

I’m not too knowledgeable about the whole health insurance/medical rigamarole. Is therapy something that may be included under my health plan? Is there a way to find out without checking with my HR person (like I really need one more person I see on a daily basis thinking there might be something wrong with me!)?

If it is covered, do I need a referral from my doctor?

I understand that there are different fields of psychology, such as behavioral and clinical psychology, etc. Would I have to know what kind of person I needed to see ahead of time? How would I find out?

I guess basically what I’m looking for is a walk-through for someone who knows absolutely squat. I’m not so worried about how therapy works in and of itself works, but just how do I go about finding out if it’s something I need, and if I decide it is, how do I initiate it. I figure how it works is something I can go over with the therapist, should I need one, I’m just a little fuzzy on the initiation process.

Thanks in advance!

Therapy may be covered by your insurance; you will have to check. Mine is; I pay a $15 co-pay with every visit. The client information my insurance company sent me had a phone number to call to get referrals. I was given several names, and I was allowed to choose. If none of them worked for me, they told me to call back. If you saved the information you received on your insurance benefits, you should easily be able to figure out the answer to this. Check under “mental health.”

To give you some background on me so that you know where my opinions are coming from: I’m skeptical of therapy and psychoactive drugs. However, I’ve been in therapy twice. I suffer from recurring clinical depression.

In my experience, your rapport with your therapist is very important. If it’s not good, you probably won’t make much progress. When it is good, however, it can make a difference.

I was a psychology minor in college, and have read extensively on the subject on my own. I thought for a long time that since I was educated and relatively self-aware, I would not benefit from therapy. I was wrong. In the last couple of weeks, through my conversations with my therapist, I have realized that I have some perceptions that are not particularly rational or founded in fact. Exposure to other points of view have helped me to realize that I have a lot more options for the direction of my career and my personal life than I originally thought.

Right now, I have a very good therapist. We have a good rapport. Last year, I saw a therapist I thought was good at the time. Since then, I have realized that we did not have a good rapport, and I got nothing out of our sessions–no insights whatsoever.

If you decide to look for a therapist, I hope you will shop around and be picky. If you don’t feel a rapport, don’t be afraid to move on and find someone you feel you click with.

As for what therapy is like: both times, we were alone in an office, and first they took my history–information about me, my background, my mental health history, my family’s mental health history. This process generally will lead the therapist to ask questions about things he/she thinks are significant. Both of my experiences with therapy were in this format–therapist asks questions, and I answer them and share my own resulting thoughts.

I do not know what the practice is with most therapists, but I’ve had about 6 visits, and now that the initial crisis has passed, we are going to put together a treatment plan. While I haven’t done this yet, I imagine that it’s going to involve goal-setting and a plan for how to achieve the things I want to accomplish.

Biology and environment both play a part in many mental illnesses. The problem can be somewhat ameliorated by finding ways to reduce stress and resolve situations that are making you unhappy or aggravating your condition. The same is true for a lot of other mental illnesses. Therapy helps you do this, often showing you issues of concern and ways to improve them that you never even thought of.

Therapy is, for me, a fresh perspective on my problems. It also serves to ground me–when you’re seriously mentally ill, you’re usually not the best judge of circumstances and the best way to cope with them.

People who do not have a diagnosable mental illness can also benefit from therapy–a fresh, professional perspective is often helpful at difficult times in one’s life. My sister’s friend is not mentally ill, but is seeing a therapist to help her deal with some tough problems that she’s facing.

As for different approaches to therapy (behavioral, cognitive, etc.): often, you will talk to your therapist on the phone before you decide to make an appointment. Ask then what their orientation is. As for what approach will help with what problems: it varies from person to person. A good therapist will be able to advise you about the best therapeutic style for your problems/concerns. If they don’t, and you don’t feel like it’s working, quit and find another therapist.

Good luck.

You may want to ask HR for a booklet that explains exactly what is covered in your health insurance plan. They should have a few booklets in the office, and this way, you would not need to reveal you’re considering therapy.

Good luck.

Q.N.Jones is so right about finding the right therapist! What I have found most helpful in a therapist is finding someone that I respect and admire. Compassion and a sense of humor don’t hurt either. You might be thinking about what traits you would want.

If you have a physician that you respect, she or he might be able to suggest a psychologist. Another possibility would be to get a referal to a psychiatrist for a general evaluation. The she or he could refer you to a psychologist. Sometimes psychiatrists and psychologists work together or out of the same office or clinic.

If you find the sessions too expensive, you might consider going every two weeks or once a month. I personally have not found formal group therapy that helpful.

Know what your purpose is. Do you think that you might have a mental illness or do you feel that you just need someone who can help you to understand yourself and to grow?

I hope that some day you will feel comfortable enough to recognize that therapy is nothing to be ashamed of.

I wish you good sessions ahead!

Thank you, Q.N.Jones, Lissa and Zoe for your thoughtful responses!

I’m still not sure if therapy is something I need, as I’m very much the type of person to try and work through things on my own. Most of the time I consider myself an extremely well-adjusted person, but about every two years I go through a major breakdown.

It wasn’t until I got married that I started taking a good analytical look at my past and realized that maybe things aren’t really as idyllic as I remembered them to be, and maybe I shouldn’t just blow off some of the negative feelings and associations I have. I’ve never really considered what I’m going through as depression, so was not certain that therapy would be something that could help.

I don’t really think that I would be particularly ashamed of therapy, but as I’m still not sure what issues exactly I’m looking to fix, it would be difficult to explain to people why I’m going.

Actually, it’s not so much that I don’t know what issues I’m facing, but more likely that there are so many that I’m not sure where to start. I’ve always been an incredibly self-reliant person, and my opinion thus far has always been that there’s nothing wrong with me that a few good friends/family and I can’t work out together. I’m not so sure that’s true anymore.

If I had to outline it, I would say that what I’m experiencing is probably more personality oriented, or residual effects from negative associations formed when I was younger. The two main things I’d like to overcome most are anxiety and guilt.

Thanks for your words of encouragement, and it’s good to know that I’ll have somewhere to turn to for answers as I search for them.

The insurance questions really vary depending on your insurance coverage. Some will only pay for providers in their network, which sometimes sucks if you don’t click well with any of their referrals. I’m with a PPO that reimburses me partially–I fill out a form and include that with the therapist’s monthly statement, then get a check back for whatever they pay, which is a small fraction of the cost.

Even though you learn in school about all the different types of therapy, in my experience I’ve found that most therapists use a mishmash of techniques—whatever works best for them. If you really want, say, a psychoanalytic or Jungian standpoint, they’re certainly out there.

A lot of therapists are not psychologists but actually Licensed Clinical Social Workers (LCSW, LICSW, LCSW-C, etc.) They tend to be a little less expensive than actual psychologists, since psychologists normally have a PhD and therapists usually have a Master’s.

The best advice is SHOP AROUND! Most therapists offer either a reduced rate or free initial session, so take advantage of that. I would advise making yourself a list of what you want in a therapist (sense of humor, a feminist perspective, etc) and ask the therapists you talk to about these issues.

Good luck and happy (therapist) hunting!

Just a 2 pence mkore to add from my own experience.
I have Insurance that makes therapy cost $15.00 per session. I am also lucky enough to be making sufficient money that this is not a drain on my resources. Given these two factors the therapy is very worth while even if it is not actually “healing” me. As simply the access to a non accusational listener is very good for me on its own. Remember that you are paying for your therapy, so if the therapist does not seem to be helping you, you can and should chose another.
So good luck, and give it a try, Cheers Bippy.

I’d like to know where Q.N. Jones and Bippy the Beardless work. In my 15 years in the computer industry, I’ve never heard of any corporate insurance plan that pays for any significant amount of outpatient therapy.

The plans I’ve been subjected to have very strict limits on how much they’ll pay – as low as $250 per calendar year, which you can burn through in only 1 or 2 sessions. Even my current plan with Kaiser, generally considered to be one of the better HMOs, will only pay $1000/year.

However, assuming that you have insurance that will pay a reasonable amount, or that you have enough money to pay for it yourself, I second the other recommendations here – finding a good therapist you can work with is essential. I spent a good part of my childhood in therapy (both individual and family); unfortunately, the therapists weren’t good, so the experience was basically a waste of time and money.

3waygeek I’m Kaiser insured. I have long term clinical depression, and get covered for 18 Psychiatrist sessions per year.
It also seems that Kaiser is not strict in enforcing the 18 * per year maximum for certain psychiatric dissorders.
Hope this helps, ask your HR or your general practitioner for more info.
Cheers, Bippy

If your company has a confidential Employee Assistance Program, you can often call a toll-free number and speak with someone immediately. You’ll be assigned a code number that is forwarded to your employer, so your confidentiality is maintained. They will them likely give you al list of names to try and tell you to call back if those folks don’t work out. In the case of my insurer, I wasn’t looking for long-term therapy, just an impartial ear/advice giver. I used about 10 sessions (during which time I realized that many of my problems would be helped if I left my job, which I did).

My current insurance covers 30 days in-patient care for mental health/sustance abuse (with a $25/day co-pay) or 30 outpatient visits with $25 copay. That’s the HMO.

StG

There are all sorts of different types of therapy/therapists, based on the many different theories behind what causes mental problems and what is the best approach to heal them.

One of the major types of therapy is Cognitive Behavioral Therapy, which has a good deal of research supporting its efficacy. This website will give you a good idea of its philosophy, its history, what you can expect to experience in the therapy sessions (in a PowerPoint presentation, no less), etc. It shouldn’t be too hard to find a therapist that practices CBT in your area, if that’s what you choose.

XJETGIRL

Without getting too personal can you talk about what is bothering you? You talk about how things were not as great in the past as they could have been and that every two years you go through some sort of ‘breakdown’.

How is the past affecting your life today? Are there things you are not moving past? What are these breakdowns like? Do you curl up in a ball and cry for a week?

My insurance has a seperate number to call for mental health things. At a previous job they had you talk to one person and then that person decided what kind of therapist you should see.
How you feel better.

Well, the Cliff’s Notes version goes something like this:

At 15, my first boyfriend was killed in a car wreck. I’ve got some guilt issues with that (I know, irrational).

At 16, I had a incredibly intense relationship that ended up in a restraining order. I had to change schools, and was ostracized by everyone I’d known previously. Again, I’ve got some guilt and negative association issues with that (again, probably irrational).

After I met my husband (but before we married), the former (restraining order) b/f came back into my life (not the first time he came back, though). After some incredibly slick talk and some really emotionally trying meetings, he made me choose. I did. Again with the guilt and whatnot.

Also, I feel like while everything is going right in my life (great marriage, back in school, financially okay, healthy etc) I still can’t get a handle on anything, and I feel like at any moment it could all fall out from under me.

As for the breakdowns, just before Christmas during my time off work, I spent about a week where I slept sporadically, cried on and off for hours, shut myself off away from everyone else in my life and basically felt like I was losing my mind. The one good thing I can find is that I actually had some time to draw and paint, and I did what I consider my best work to date. For an entire year prior to that though, I felt like I was a zombie, my only purpose in life was survival.

Prior to this they’ve usually been a lot worse, but I just attributed it to teenage hormones and such. My parents even had to break down my door one time to make sure I wasn’t doing anything stupid when I had locked myself in my room to, well, have a nervous breakdown.

My recent breakdown felt like an awakening, and I’ve been thinking about therapy ever since.

Also, I have issues sleeping, and my doctor refuses to really look into my symptoms seriously. I’ve had three visits that all consisted of basically:

“Well, you’re a young kid, don’t worry so much and try to get to bed earlier. You’ll bounce back!”

Feh.

I’m not sure what any of the above have to do with each other, or with my problems right now, but I guess that’s what therapy is for, eh?

I didn’t want to bore anyone with details, but I guess some reference point is necessary. Wow, looking back this is a bit longer of a response than I had originally planned. I don’t really mind getting personal, I just don’t want to get all look at me I need attention! about it. I just don’t know where to start looking into this, and I’m still half convinced that if I just buck up and fly right I’ll be okay.

Thanks gallows fodder for that CBT link. It’s something I’ll have to look into, and thanks to all who have posted.

My former employer’s health insurance also covered therapy. I found out by calling the number for information about benefits on my insurance card.

I was actually pretty resistant to going back into therapy because I thought I no longer needed it. Then, starting about two years ago, I started digging a bit deeper, re-examining some basic ideas I had (around that time I told a couple of friends I didn’t need human contact and meant it), and opening and trying to heal old wounds. The friends who were helping out with this are wonderful, caring people, but they are not therapists, so I found one.

She uses a variety of techniques, including some that appear to be derived from CBT. One thing she focuses on with me is where some automatic responses are coming from and what some of my basic assumptions are based on. For example, I’ve been beating myself up quite a bit since I got laid off. When I tell her I feel useless, she gets me to look at the source of that feeling and to realize that I’m holding myself to a harsher standard than I would anyone else. She also uses some physical techniques. For example, I’ve been known to decide I’ve left the iron or the toaster oven on and worry about it for the rest of the day. It’s not full-blown OCD, but it is decidedly uncomfortable. She suggested a routine of tapping various parts of my body to help dislodge the thought. It sounds crazy, but it works.

One word of warning. For some reason, when I decided I did need to get into therapy, the first five I called were all fully booked and not accepting new patients. As I complained to one of the friends I mentioned, it was not helping my problems with depression and rejection. I don’t know what things are like in your area, but don’t give up. The therapist I’m seeing now is wonderful, and I would strongly recommend her to anyone. She’s done me a lot of good, and I can easily say she’s one of the two best therapists I know (the other is up in Maine).

Good luck,
CJ

Some very good advice in this thread. I second StGermain in saying that if your company has an Employee Assistance Program, that can be a very good route to get confidential information. I was very skeptical when I called mine, but they set me up with a free consultation the very next day with a therapist who had experience with my issues.

I also second the advice to make sure you find a therapist with whom you feel comfortable. Before calling the EAP, I had been to two (both recommended by my doctor) who did nothing for me.

One point that hasn’t been touched on here is that you don’t need a specific problem in order to benefit from therapy, and many of the people I know who have benefited, myself included, went in for help with one particularly troublesome issue and ended up sorting out all sorts of other issues in their lives. It certainly sounds like you have a lot to deal with, and a therapist may be able to give you a better perspective, or even to help you see which issues you need to resolve in order to feel better (not to mention sleep better).

One final thought – one of the things which initially scared me about therapy was that I thought of it as “all or nothing” – once you’re in, you’re in for good. But it’s not a longterm commitment. All you have to do is try one session. If you don’t like it, just quit, or try a different therapist.

i’m seeing a counsellour at uni (it’s ireland, and it’s free, so not much help there) which has actually been pretty great.

i’m one of the people who bottles stuff up and then explodes, and finding out that simply talking about things can make them effectively go away has been a real eye-opener.

my counsellour is one of those really cliched people who pushes tissues towards you and says “and how does that make you feel” every 5 minutes. she alternates that with " it’s perfectly natural for you to feel that way".

weirdly, it works.

so, definitely, give it a shot, and wait for at least 3 sessions before you give up.

sorry, i’m being a bit facetious.

my counsellour has actually helped me to gain some real insights into my self and my family.

i say give it 3, some sessions will always be more rewarding than others, sometimes you won’t want to talk, and it takes time to open up to someone properly.

if you do go ahead, i’ll warn you that i had some fairly horrible times as repressed memories and thoughts made themselves known.
cue nightmares etc.
but they go away pretty sharpish once you deal with them, and don’t stay lurking any more.

gosh, i know this isn’t the sort of input you requested, but i hope it helps in some way.

all the best for whatever you decide to do.

I was in therapy for 6 months a while back after I was hit with the death of someone very close to me. I too had feelings of guilt (also intense feelings of fear and anxiety) that I knew were irrational–yet they were still there.

My therapist helped me enormously. Looking back, it seems almost like things had just clicked wrong in my brain for a while, and she helped me get them functioning correctly. I was very doubtful going in. I think that’s pretty common. But it really did help.

Yes, my insurance covered all but a $15 co-pay. I didn’t have to call my HR generalist, but I did have to call the insurance company to get a referral to someone in their network. Do they have a general information number you can call?

My therapist was a lisenced nurse counselor (I’m afraid I don’t recall her official title) not a psychiatrist. I was put on anti-depressants for the anxiety issues and had to go to a separate psychiatrist to get the perscription. Don’t panic, they won’t automatically put you on medication. I was placed on the medication only because my anxiety was so very pronounced and I couldn’t get any benefit out of the therapy itself while I was still in such a panic state.

I don’t recall ever finding out if my therapist was any particular type. We did do a lot of the cognitive behavioral therapy techniques. So maybe that was it. I must say, it’s great stuff if you’re in the situation I was in where your brain is stuck in an algorhythm run amok!

If you’re doubtful as to whether you need therapy, a good therapist will tell you if you don’t. After 6 months, mine said we were ready to say goodbye.

Great advice here, people.

If it turns out your insurance won’t cover psychotherapy, one free or low cost alternative not enough people know about is the clinic run by your local university. If they have a psychology department (and they probably do) they will have a clinic for their students to use for practice. The graduate students are well supervised and in general the quality of therapy is quite good.

I’ve been in and out of therapy for a few years now (the parental units think it’s a good idea, I don’t). First peice of advice, and IMO, most important: DON’T let them give you any drugs. In very severe cases, psychoactive drugs may or may not help. In most cases, they make the problem worse and a huge number of psychiatric drugs are addictive (and overperscriped). Granted, this is my incredibly bitter ranting, as I’ve been to six psychologists in five years for varying amounts of time. Every one of them has eventually tried to ‘fix’ me by giving me drugs, and there have been various diagnoses (ADD, ADHD, bipolar, chronic depression, etc…)

Two: If they make a ‘diagnosis’ in under, I’d say three hour-long sessions, forget it. I’d say doubly so if you’re a teen.

Unfortunately, I’m not sure exactly how it’s supposed to work, because despite numerous first sessions, I’ve yet to be taken to a psychologist who didn’t get a medical history from my parents and then sat me down and more or less drilled me about my possible problems. You will, however, be expected to talk about things you really don’t want to talk about, as said Irishgirl . Unpleasantness abounds, but some people say it’s worth it. I think it’s really somethign you need to judge on your own.