What's the SD on therapy?

In My Humble Opinion
1

The concept of “going to therapy” is one of those things that’s ubiquitous in popular culture, yet I’m stumped as to how to go about finding my own therapist. I did take advantage of the free therapy offered by doctorate students at Student Health Services in college, but now that I’m in the real world, I have no idea where to begin.

Essentially, I want to blow my $40 deductable a handful of times in an attempt at self-improvement. There’s nothing earth-shattering going on in my life, but I’d like to work through some lifelong issues (mainly in the realm of social phobia) with someone impartial.

My PPO lists dozens of local doctors in the categories of psychiatrists, psychologists, and counselors. So first, I need to know in which of these three categories I should be looking. Second, I need to figure out which doctor is right for me. Is there an “Epinions”-type site for medical professionals? Or should I just choose based on proximity and hope for the best?

2

Huge topic that can and does fill volumes. I will give you a start and I speak from much academic and personal experience:

  1. Psychiatrists - great for dealing with medically correlated psychiatric problems. These could range from moderate depression, to schizophrenia, to Bipolar Disorder. Some do talk therapy also although insurance companies and the general trend usually dictate that the regular long talk sessions be left to the ones below.

  2. Psychologists - They don’t have a medical degree. It is usually a Ph.D. or Psy.D. academic degree. They have more formal training in the science of psychology than psychiatrists do. Psychologists sometimes specialize in one are of psychological treatment like cognitive therapy. Psychologists are good at giving things like psychological tests and working under specific clinical paradigms to treat certain types of disorders like phobias, eating disorders, and some adjunct areas of the disorders listed under psychiatrists.

  3. Counselors and Licensed Social Workers - these tend to be the more nuts and bolts people. If you have practical issues that you have issues with, need someone to listen, and would like more practical advice, these are the people to go to. They tend not to have the highest academic degrees but they focus on practicality and real-world results. Some that specialize in things like addiction have been there and done that and approach the problem in that way.

Stereotypical Freudian type psychoanalysis is generally out. You should pick the type of clinician based on the closest match to your problem and goals.

3

You want to look for either a psychologist or an MFT (marriage family therapist). Psychologists have doctorates, while MFTs have Master’s degrees in psychology.

Your OP mentions “social phobia,” which is an actual disorder, but there is no way for me to know from your OP if i’s actually a correct one for you (nor would I ethically do this anyway). But you do mention that these issues are long-standing. Given that information, I’d suggest working with a psychologist rather than a counselor. A psychologist is trained and competent to diagnose and treat, where technically people with MAs are only trained and competant to provide counseling and guidance- work on marriage issues, for instance.

Now you need to decide on the type of psychologist to see. Most likely you will find three “flavors” of therapists- CBT, psychodynamic, and humanistic or client-centered.

CBT stands for cognitive-behavioral therapy. It is an empirically validated first-line treatment for depression, phobias (including social phobias and anxiety), and anxiety. This means scientific studies have shown it is the best & most effective treatment to try first for these types of disorders. In general CBT involves learning to identify problematic thoughts, assumptions, or automatic “snap judgements” you make in situations, about yourself, etc that cause the anxiety and learning to challenge and change them. CBT involves “homework”- writing things on special worksheets, practicing new skills, keeping a log of anxiety and triggers, etc. CBT is not like the “talk therapy” you see on TV as much. Clients are more involved and no one cares about your mother (unless she is a specific trigger). CBT is usually short-term therapy- 8 to 15 sessions.

Psychodynamic therapists do what you see as “talk therapy” on tv or in movies. Clients sit with a therapist and discuss their issues. The therapist helps the client gain insight, or recognize how their difficulties relate to events in earlier life, or learned patterns of relating to people as children (such as a bad relationship with your mom makes you scared of chicks now). This can also be called “insight-oriented therapy”. The goal is for the client to gain insight into themselves and their behaviors, and through transference and a corrective relational pattern with the therapist have healthier relationships and understand themselves better. Also empirically validated for certain disorders, but for anxiety and depression CBT is still prefered as the first course of action. However, some people feel more comfortable talking things out rather than doing homework. Psychodynamic therapy tends to last longer than CBT.

Then there’s humanistic or client-centered therapy, also called “Rogerian therapy” because the guy who really started it was Carl Rogers (he looks like Earl Reddenbacher the popcorn dude). Client-centered therapy really allows the client to dictate the session content. We don’t talk about your mom unless you really wanna. The therapist practices “unconditional positive regard”, meaning they hold you as a good person even when you act like a shmuck. It’s also non-directive- the therapist won’t try and steer you towards changing in any particular way. As my clinical supervisor way back in the day said, “client-centered therapy’s best gift is that it gives people the experience of really being heard, which for a lot of people is so new and needed it’s life changing in and of itself.” I, however, will probably never be able to shake the mental image of a bow-tied old man whenever I think of it. Rogers is entirely to blame. Well, him and 70’s fashion.

Choosing a therapist can be tricky. Recommendations from friends can be useful. Failing that, I’d call a bunch from your network, find out if they practice the flavor you’d like to try, and see if you can get a good sense on the phone for if they sound like someone you’d like to talk to or not. Many therapists will allow you to schedule a “mini session” for 10 or 15 minutes for free so you can meet them (and vice versa), and get a better sense of if you’d like to work with them or not. You can also ask them questions about how they like to work, how long clients tend to be in therapy with them, their experience/degrees, and any other questions you may have, barring ones of a personal nature.

You may wish for a therapist of the same gender, or not. Or maybe you don’t know or care. Any of the above is fine.

Ok, off with you! Time to sample the shrink buffet!

4

Agreed. The few analysts left tend to be in major metro areas like New York or San Francisco and associated with analysis schools. Analysts do not take insurance. You will not encounter one in the wild unless you specifically go hunting.

Nobody lies on couches. No free association. No ink blots except in rare testing circumstances and they are very unlikely to happen to you. No one smokes pipes either. Nor does anyone mention “castration anxiety,” “oedipal complex,” or “penis envy.” No unfortunate nasal surgery either.

5

Thanks to both of you for your informed responses. From what I’ve been reading, I feel my best bet may be CBT. I think the brief stint I had in college must have been Rogerian therapy, since I remember doing all of the talking, aside from prompts. It proved useful for working through a specific relationship issue.

If this page is accurate, then I may indeed have Social Anxiety, perhaps to a somewhat lesser degree than described.

6

Ther are some Californian CBT practitioners/resources here.

7

therapy (noun) — by analogy to prostitution, “a piece of ear”. Presumably sympathetic listening (or at least listening concatenated with the desire to “help”), perhaps but not necessarily coupled with advice, with the provision of exercises, or with recommended changes in behavioral patterns. All dished out in 50-minute servings in exchange for recompense. The secular priesthood, the modern replacement for “consulting the wise ones”. As with historical and cross-cultural parallels, the modern incarnations may be vested with authority over those who seek them out, either informally (as part of how the therapeutic relationship is constructed, see entry for paternalism) or formally (see entries for police powers, psychiatric commitment, and parens patriae).

A good therapist will generally teach that the realizations and changes are wrought by the client, with the therapist operating as a catalyst rather than as an agent of change. Many therapists feel that people seek therapy at a time in their life when they wish to and/or are ready to undergo change, and believe that people find it easier to process their way towards change if they have someone to bounce their thoughts off of and get some feedback. Quite a few therapists believe that people also resist change and cling to mechanisms that prevent change, and consider it part of the therapeutic process to thwart their clients’ attempts to prevent necessary change. (This can sometimes manifest itself as hostile and/or contemptuous attitude towards clients).

Most therapists hold fewer ideas about the “ideal properly-adjusted mentally healthy person” than the general public (and the typical client) does, with the general exception of psychiatrists (who are medical doctors, i.e., medical-model therapists), although therapists are not categorically immune to such notions. Some therapists are more inclined than others to leave the defining of outcome goals and whatnot exclusively to the client (i.e., if you are comfy with being a suspicous fingernail-biting bitter hypochondriacal lonely person, and just want to get over your insomnia and agoraphobia, they won’t push you to expand your definition of your Problems). Some therapists are more inclined than others to see society as “political”, i.e., to see some portion of personal mental/emotional pathology and life-issue shit as symptoms of injuries done by society to the client (categorical oppressions of out-groups, noncategorical dehumanization of all individuals, etc).

There are also self-help / “peer counseling” / mutual-support alternatives in which no one is the designated therapist. The participant would be expected to listen and give feedback to other participants in kind. Participants are far less likely to have received any comprehensive formal training in any therapeutic school of thought, although some may be well-read or even obsessive students of therapeutic theories, make of that what you will. Through its mutuality, the “piece of ear” / paternalism dynamic is largely eliminated, something I tend to regard as a significant and overriding advantage. There tends to be a much flimsier separation of therapeutic relationship from informal “friends / acquaintances/ lovers” type relationships, though. So you can either put a lot of energy into seeking out a relationship with a conventional professional therapist that’s not overly imbued with paternlism or you can put a lot of energy into seeking out mutual self-help environments that give a solid commitment to the separation of therapeutic relationships from other relationships, and again I would recommend the latter option.

8

I don’t think that there’s a single concise answer to your quesiton, so in addition to the ones you’ve already received, let’s move over to IMHO where you can gather more informed opinions.

samclem GQ moderator

9

Possibly helpful stuff to know:

You can ask for recommendations from other people in the field (would the people you saw in college be likely to know anyone where you are now? Do you know anybody else in the counseling field?) or from friends who have been treated for problems similar to yours.

Don’t hesitate to switch therapists if you feel the need. They’re the experts, to be sure, but they’re also being paid to provide a service. If a given therapist isn’t helping you, move along. However, if you have a similar problem with more than one therapist (say, you feel all of them are too critical), it’s possible the problem is your perceptions, not their actions.

Psychiatrists (MDs) are the only ones who can prescribe meds (AFAIK this is the law in all states), though a psychologist or other non-MD can treat you while you’re on medication. If you think you might need meds (if, say, your anxiety has a big physical component, like profuse sweating or hyperventilating), start with a psychiatrist. If you definitely don’t want meds, perhaps you shouldn’t start with a psychiatrist; some insurers lean on psychiatrists to pick a pill and move on to the next patient.