You should see a doctor for that…

Posted by on May 10, 2019

Have you ever heard or even said that sentence? Regardless of which side of that suggestion you were on, I bet it wasn’t for a mental or emotional problem. Can you imagine? Perhaps someday…a psychologist can dream, can’t she? Either way, seeking help for mental, emotional, and psychological problems is gaining acceptance and the stigma is slowly decreasing. Over the past few years, several prominent or famous people have “come out” about their mental health, paving the way for others: Michael Phelps, Kevin Love, Demi Lovato, Chrissy Teigen, Prince Harry, Dwayne Johnson, Ryan Reynolds, Cara Delevingne, and Kendrick Lamar, to name a few. Major corporations are helping to remove the mental health stigma of seeking help by not only making it a priority, but “normalizing” mental health conversations. In 2009, Fast Company published an article about companies hiring a Chief Wellbeing Officer, which is really starting to get some traction now, a decade later.

Besides the barrier of social stigma, how to find the right mental health professional stands in the way for many people who are ready to get help. As a Psychologist, here is my advice for how to find the right fit for you and your needs.

  1. Types of Mental Health Professionals:

Psychiatrist: Technically a Medical Doctor with an M.D. or D.O. (Doctor of Osteopathy) behind their name. Psychiatrists can do therapy but are more likely to manage medicines for a patient (some do therapy but not all). If you are taking or it is suggested that you take a psychotherapeutic drug, for example SSRI’s such as Prozac, Zoloft, or Lexapro, having a Psychiatrist manage this medicine is better than your “regular” doctor because they are specifically trained for this, have much more experience with interactions and side effects, and typically have a wider range of medicines because of their training.

Psychologist: They are licensed by state and have a doctoral degree, such as Ph.D., Psy.D., or Ed.D. Clinical Psychologists provide short-and long-term care, some do psychological testing and interpretation, and can bill insurance (some even take Medicare or Medicaid). Most will have a specialty, or area where they have the most training and experience. Research Psychologists primarily do research (duh) or collect data to further our ability to treat in new ways.

Therapist: A counselor or therapist that is licensed and they hold a Master’s Degree (M.A.). Licensed Clinical Social Worker (LCSW), Mental Health Counselor, or Mental Health Nurse all have training and expertise in psychology, therapeutic techniques, and deliver services in similar ways to the previous two professionals described.

The similarities are that all mental health providers have education, training, and experience in certain treatment areas, provide individual, family, and group sessions, can be independent practitioners or part of a group, hospital or wellness center, and all want you to be well. The differences are in the amount and type of training. Psychiatrists are trained as medical doctors first and then specialize in psychiatry—and are the only ones on this list that prescribe medicines. Psychologists have “more” education and training than Master’s level therapists but be careful because that does not necessarily make them better. Really, training is only as good as the trained. Liking your therapist matters most.

*Note: Non-professionals such as life coach, personal coach, wellness coach, consultant, resiliency expert, etc. have a role, but not as mental health professionals. While people using these titles want to contribute and help you, they are not formally trained in psychology and are not prepared to deal with or diagnose many issues. While they may have been through tough stuff, that doesn’t always qualify them to help you through yours. This is tricky for a Psychologist to talk about so please note my opinion here is completely biased. Well, the unbiased part is that none of these people are professionally licensed, which means there is no oversight or regulation of ethics or how prepared they are to deliver whatever services they claim to be able to deliver. Getting advice is easy and these days, everyone has some to give. The question is really about how the “advice” is informed and what kind of training is behind it. I am admittedly a snob about degree and licensure because it took me nearly a decade to become a “professional.” Add to that annual requirements for continuing education in licensure to keep me up to date on current research and practices so that I continue to improve and grow as a practitioner. Think about matching your issues and needs with your practitioner.

  • Theoretical Orientation:

This is a fancy way of saying how they conceptualize you and your treatment. Each one has a different way of assessing you, your situation, your circumstances, your responses, and your treatment. It is like a lens they look through and each practitioner chooses a theoretical orientation based on how it resonates with them during training. In all honesty, if you never knew this or asked about this, it would NOT make a difference. Liking your therapist matters most.

Cognitive-Behavioral Therapy (CBT): Cognitive is thinking and behavioral is well, behaving. CBT helps you identify and become aware of your thoughts and actions that might be causing you stress or problems and then teaches you new ways to think and behave. It is much more action-oriented and tends to have a quicker impact.

Psychodynamic or Psychoanalytic: Psychodynamic treatment can take longer than CBT because it takes more of a look back at your history and relationships. It is more reflective and introspective in design. Psychanalytic is yes, you guessed, from Freud’s original theories, but definitely updated. Its focus is more on the unconscious and dreams than the others and is a long-term therapeutic commitment.

Family Systems Theory: is more of an integrative and holistic approach to the person. It looks at the entire system a person lives in and how each part affects each part including relationships, patterns, communication, and behaviors.

  • How to find a therapist! This can be daunting so here is the advice I give everyone:

First, have a goal for treatment. Why are you seeking a therapist or psychologist? This does not have to be complicated or long-winded, it can be as simple as you want to feel better. Having an idea of why you are going and what you want to get from the process is a powerful way to start. Remember, psychology is a “soft” skill environment. It is not like physical health care where they measure things with blood work or scans or machines. You are going to “measure” your psychological health by how you feel…and how you feel is important! What are you struggling with? It is very easy to say anxiety or depression because those terms and descriptions are all over the place so look to see how they are impacting your life. Did you lose someone and need support with grief? Do you need direction in your work or relationships? What are some common repetitive themes your wrestle with that you are tired of losing to and would like to get some power with? You will have physical repercussions from your mental health struggles so don’t ignore the fatigue, exhaustion, tearfulness, anger, upset stomach, or racing heart when you talk to your therapist.

Second, begin your people search with your health insurance company. You can self-refer for psychological services, so you don’t need a doctor’s referral. Call them (make sure you have time to do this so that you don’t get frustrated with long hold times) and ask about your mental health benefits and finding someone in your area. If they have a good website with a good health care provider list, go there. Start with your zip code, either at home or work, because getting to your appointments is going to be confronting enough, you want to make it as geographically desirable as possible!

Other places to get good referrals are your Primary Care Provider (PCP), Internist, or even specialty doctor. If you feel comfortable talking with them about your issue, they just might have someone they know and trust in their referral network. Remember, they are bound by HIPAA so legally cannot disclose this information even if they wanted to. If a specific physical health issue is driving your mental health issue, then this is especially important to talk to your doctor about.

Friends, co-workers, and neighbors—to the best of your comfort level. Not everyone is ready to talk about seeking psychotherapy with anyone (or everyone as I have seemingly suggested—not really). IF you have strong and trustworthy relationships, then asking the people in your circle makes sense. If not, don’t. Don’t add to your struggles and don’t think twice about that, there are other ways to find a psychologist.

If you don’t have insurance or a doctor, the internet has made it much easier to find this kind of help. A simple search engine with some key words can get you all the websites of local practitioners. In addition, you will be able to get a sense or feel for the person and know quickly whether or not you actually want to call them for an appointment.

Now, once you find someone, INTERVIEW THEM! This is not a swipe on Tinder, people! This is your mental, emotional, and psychological health and you want someone that is a good fit for you! (enough exclamation points there?) Not every psychologist will grant an interview like this, but I have found it incredibly useful and time/money saving in the long run so go ahead and ask. In all honesty, I use the free 15-minute phone call as a form of interview from my perspective, as well. I am not a good fit for everyone nor am I trained to treat everyone so often, I can see this in a quick chat as opposed to wasting everyone’s time with a scheduled session. Here are the interview questions I suggest:

1. Do you regularly treat xyz (what you are struggling with)? Have you had many patients with xyz? (You want this to be a resounding yes.)

2. Do you have a Psychiatrist you work closely with? (You may not need this, but if meds become an option, this is good to know.) Do you have a Medical Doctor you work closely with? (Remember, mind-body, it all works together!)

3. What is your theoretical orientation? (This may or may not matter so skip if it is not important to you.)

4. How do you treat xyz? (How they answer this will tell you more about their energy and feel than really wanting a technical answer. You want to like how they speak to you and explain things to you because that is critical in therapy.)

5. Do you take a month off in the summer? (Many shrinks vacation the entire month of August. This may or may not matter to you but good to know.)

6. Depending on their age, make sure they are not ready to retire in the next few years.

Number of sessions. This is tough and has many variables impacting the answer. The first variable is going to be what you can afford—both in time and money. Be honest with the person you choose in case the restrictions pose a problem for how they do treatment. If they have a system and you cannot be completely consistent, then you both will waste time and money. Depending on the severity of your issues, each practitioner will mostly likely have a recommendation for a short-term or long-term session commitment. This is not a ploy to make money. Treatment takes time and you need enough time to have ups, downs, and the in-betweens for therapy to work.

Gender, Age, and Ethnicity of the therapist are all things to consider, if possible. You want to be sitting across from someone you feel comfortable with, period. So, only interview those that fit your picture. If you are not comfortable talking with women, find a male therapist, and don’t apologize for feeling that way. You don’t want to worry about being understood so use that criteria when choosing whom to call.

Lastly, money. If your insurance is covering it, great, if not, ask for a discounted rate or if they have a sliding scale for payment. Most psychologists and therapists I know have a few places each week for those who cannot pay full-fee. Those are the kind of folks you want to work with anyway…

  • How do I know it is a good fit?

Hope. You will feel hope as you leave your first session and you will want to go back. You will also feel like you could eventually trust this person with your deepest thoughts and feelings. In reality, you will feel guarded and uncomfortable during your first few sessions (maybe even months), but you should also have flashes of trustworthiness, affinity, and hope mixed in there. Talking to a stranger has a strange effect and a pleasant feeling of relief. You should like them and develop respect for them early on. They should be further along in this journey than you are otherwise they cannot guide you anywhere. They should be able to press you a little when the time comes, so be prepared for some discomfort leading to that desired growth. And you should absolutely feel like they are telling you the truth and not just saying things to make you feel better—no one needs to pay for that!

  • How do I know it is working?

If you think about how long it took you to get jammed up, it makes sense that it will take you a while to get better. The toughness and resiliency of the human mind and body allows us to get in pretty bad shape for a pretty long time before we need help, unfortunately. Give it time, more time than you want to. It is a process and therefore cannot happen all at once. Be prepared to have a bit of a rollercoaster with your sessions because getting to the other side of things is not all roses and cotton candy. Commit to getting better, trust the person you are working with, and hang in there. How you know it is working comes after the fact, meaning, you will be going about your day, something will happen, and you will react better, smarter, and recover faster. It won’t register until later when you either think or say to someone, “Wow, I just didn’t unravel like I usually do.” That is when you smile, give a little self-high-five for your good work, and keep on working.

Your mental health is important to your physical health and vice-versa. Our world has become a place of stress with constant assaults on the mind. To not just survive but thrive in that environment takes work and help, so let’s make sure we get it. Thank you for reading this and helping us all to move the needle on making mental health normal. Everyone needs help at some junction in life so be honest and then brave about helping yourself and then others. We all depend upon it.

“Not until we are lost do we begin to understand ourselves,” Henry David Thoreau.