Taking risks in therapy

   

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We all have something that we don’t like to talk about. While therapy is an appropriate setting to explore these issues, we sometimes hold back on certain things — even in that context — out of fear. “Will I sound crazy?” “Will I be believed?” “What will my therapist think of me?” “What are the consequences of saying this?” “Will my therapist think less of me?“ These questions and more prevent us from being completely open in our treatment. 

But if you never take risks, you won’t progress when it comes to those issues. In fact, they may become worse as feelings of shame, embarrassment, guilt, hostility and unworthiness fester inside of you. The fact that you won’t talk about the topic becomes an issue in and of itself. 

The first obstacle you need to pass is trusting your therapist. You can read more about that here. In short, developing a strong therapeutic alliance in a safe relationship allow you to be more open. Keep in mind the ways in which your therapist has been trustworthy in the past. If you remind yourself of these things, opening up might not seem quite as impossible.

Still, even with trust, it can be hard to explore certain topics. I spent a lot of time trying to figure out how to talk about a series of events that happened a few years ago. I had been seeing the same therapist I’m seeing now at the time these things happened and my irrational fear was that I’d remember things wrong and become discredited. But I have yet to find a way around those fears. So what could I do?

It got to a point where my only options seemed to be to keep quiet and never heal or to take a risk and see what happened. After years of deliberation, I decided to just go for it and see what would happen. For me, that meant telling the story regardless of my fears. So I did. 

I was not prepared for how well that went. At first, I addressed my concerns about how he might remember things differently than I did. I asked my therapist to not go back and read his notes from the time in question and he agreed to follow my request. This removed a lot of pressure. 

It’s going to take a while to get through everything. And that’s okay. Breaking the larger story into smaller segments allows me to do a little each week. This way I get insight into each part, which helps me understand the larger context at play. While the content is very difficult and, at times, triggering, I’m feeling better about myself and am more realistic about my role in those events.

Jumping in is not always the solution, but I’m pretty sure that at this point in the post, you have a specific issue or situation in mind. Test the waters. See what happens. Be honest about your concerns. You can discuss them before you get to the actual content. But when you’re ready, opening up despite fear can be extremely healing. I know it has been for me.

What risks have you taken in therapy? How did it work out? Tell us about it in the comments.

10 commonly used psychological assessments

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Sometimes, meeting with a client in therapy isn’t enough for a therapist to know what is going on. You are seeing someone out of her regular context, moved into a intrusive (though supportive) environment. You aren’t the same self in therapy as you are the rest of the time, so it can be good to get a closer look at traits and symptoms. If your therapist needs more insight into your situation, he might request that you take one or a series of assessments. Following are some of the most widely used ones.

1. Clinical interviews

Clinical interviews are a series of set questions that focus on any symptoms you may have, helping the clinician better assess if you have a diagnosable disorder. During the interview, you will be asked open-ended questions. The interviews generally last between 30 minutes and two hours. Sometimes, the clinician that is administering the test will assess 

attitudes, appearances and behaviors in order to 

supplement the verbal answers given.

2. Screening inventories 

A screening inventory is an assessment that is looking at client symptoms and distress. They can be used both to diagnose mental illnesses and to look at therapy progress and outcomes, depending on the test and context you are taking it in. For instance, the Outcome Questionnaire-45 (OQ-45) can be used before each session to check in on where the client is at. The Beck Depression Inventory (BDI) might be used to get a better handle on a client’s depression symptoms. The Symptom Checklist-90-R (SCL-90-R) might be used to look at a number of symptom clusters while conducting a psychological study. There are a wide variety of tests to suit many purposes.

3. Rorschach test

The Rorschach test (also known as the inkblot test) is perhaps the most famous psychological test of all time. It is a projective assessment wherein the subject is shown a series of symmetrical images created by ink on paper. The subject says what she sees in the images and the test administrator will write down everything, no matter how trivial it may seem. These statements are later interpreted in regards to personality, emotional functioning and to detect thought disorders. 

4. Thematic Apperception Test (TAT)

The TAT is another projective assessment. In this one, the subject is shown ambiguous images of people. The client will tell the proctor stories about the individuals the pictures, which can be interpreted in a multitude of ways. This test is considered a glimpse into the subconscious and the way people see the world. It has been used to study a variety of items, such as motives, concerns, personality and emotional stability. 

5. Rotter Incomplete Sentence Blank (RISB)

A third commonly used projective test is the RISB. In this assessment, the subject is given a list of 40 sentence stems, or incomplete sentences. These are deliberately vague and encompass such phrases as, “I need…,” “Other people…” and “My greatest fear…”. The subject simply completes the sentences however he wants. There is not much in terms of standardized scoring, but themes will emerge, such as a preoccupation with ones appearance or social anxiety. These can help the therapist better tailor treatment to areas of concern. 

                                                                                                                   6. Wechsler Adult Intelligence Scale (WAIS)

   

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The WAIS, currently in its fourth edition, is an intelligence test. It measures raw intelligence and gives you an IQ score. The average IQ is 100. It focuses on a variety of areas, including working memory, processing speed, arithmetic and vocabulary. It has questions ranging from picture completion to finding similarities between words. This test measures your aptitude, not how well you are actually doing in the areas tested.

7. Woodcock-Johnson Tests of Cognitive Abilities

The Woodcock-Johnson, in contrast to the WAIS, is made to measure cognitive performance. It shows how well you actually do in the areas of math, reading and writing. You may score higher or lower than your actual IQ would indicate; for this reason, it can be useful in identifying learning disorders. 

8. Minnesota Multiphasic Personality Inventory (MMPI)

The MMPI is the most commonly used psychological test. It is used to assess personality and psychopathology. Depending on the version of the test you take, you answer either 338 or 567 true or false questions about yourself. This is used to gauge your level of pathology in areas such as depression, hysteria and paranoia. Based on the areas you have the highest scores in, a portrait of your personality and psychological issues can be made. There is also an adolescent version of this assessment, the MMPI-A, which is 478 items long.

9. Millon Clinical Multiaxial Inventory (MCMI)

Used strictly to assess psychopathology, the MCMI does not tell you about personality in the same way the MMPI does. It has a clear focus on psychological symptoms, as it identifies personality disorders and clinical syndromes. It is, however, much shorter than the MMPI, only having 175 true or false questions that can generally be answered in 25-30 minutes. The adolescent version of this assessment is called the Millon Adolescent Clinical Inventory (MACI) and is 160 items long.

10. Child Behavior Checklist (CBCL)

This test is designed to be used with minors, starting as young as 18 months of age. A parent or caregiver takes the test and reports social, behavioral and emotional observations of the subject. There are also versions of the test that can be filled out by teachers or the youth themselves. The assessment asks how true certain statements are, such as “talks or walks in sleep” or “acts too young for his/her age.” Because parents and teachers have higher access to the youth than the therapist does, it can be helpful to get input from someone used to seeing the child in other settings. 

Have you taken any psychological assessments? Did you learn anything interesting about yourself? Talk about it in the comments. 

What to expect your first session

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The first session with a therapist is a unique experience. It is different from all future sessions, which will be dictated by what problems you are facing. But in that first hour, there is lots of important information you and your therapist will be going through. Every therapist is different, but here’s what you might expect in your first session.

First of all, arrive early. There is likely some paperwork for you to fill out. Some of this will be

financial. This would include insurance information, so make sure to bring that with you. If you don’t have insurance, you may have to sign a contract stating that you take financial responsibility for paying for the sessions. You might also be asked to fill out questionnaires about your symptoms and history.

You might also be given a paper stating the limits of confidentiality. Whether or not you get the paper, your therapist should talk to you about it and answer any questions you have. You can also read more about confidentiality in therapy here.

You may have filled out paperwork on it already, but your therapist will likely ask you about your background and what symptoms you are experiencing. Be completely honest. You’re not going to be rejected for telling the truth. Only if you are open can your therapist formulate the best possible treatment plan for you.

There will also probably be questions about your current situation – occupation, relationship status, living situation, family and social relationships, and so on. This is done to get a better idea of the stressors you might face and the support you have. Again, be honest. You’re not trying to impress anyone.

The most important question, though, is what brings you to therapy. Think ahead of time about what you would like to accomplish with your time together. You don’t need to know exactly what the plan is – that’s something your therapist and you will come up with together. But a basic idea of what you want to change in your life is very helpful and an important starting point for treatment.

With all the questions you are being asked, you probably have some of your own. That’s perfectly appropriate. Now’s a great time to learn about your therapist and the process of therapy. Some ideas for questions you might want to ask are here. 

What you shouldn’t expect, however, is for problems to be solved. Some therapists might jump right into the issue and leave some of the questions discussed for later, but even then, remember that therapy is a long-term process. If you have an imminent emergency, make that clear to your therapist early on, but if not, let the first session be what it is. It’s a time for you and your therapist get to know each other and make goals for treatment.

What has your experience been with first sessions? Tell your story in the comments.

Why you should see a student therapist

Every therapist has to start somewhere, so there are plenty of student therapists who are practicing under supervision. They can often be found in university counseling centers and in community clinics. This means that college students and those utilizing community resources may well end up working with a student therapist.

   

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Not everyone is entirely comfortable with this. If you’re a senior citizen, how can you put your trust in someone in her twenties? Does a student feel like he is getting appropriate treatment when his therapist only a couple years ahead? It’s an issue that student therapists have to deal with sometimes. The thing is, they shouldn’t have to.

Research shows that student therapists perform just as well as licensed practitioners. Some even suggests that they might actually be better. The reason for this is unknown, but it could have to do with being regularly supervised, the fact that their education is still present or recent, and the initial zeal that old hands lose. No one knows for sure. What matters is that you shouldn’t be worried about having a student therapist – you might actually be better off that way.

Supervision allows students to have a second pair of eyes on their clients. Supervisors often watch tape of students performing therapy, meaning they can give very detailed and relevant feedback. Students also have someone who can help them conceptualize their clients and give suggestions. It’s kind of like having a second therapist behind the scenes.

By virtue of being in school, students are actively learning. They are dealing with the material both theoretically and practically. They spend a lot of time actually thinking about all the things that lie behind therapy, something a seasoned clinician might not do. Students also have multiple professors at their disposal, meaning that experts are on hand.

Students are also enthusiastic about their work. They are at the very beginning of their careers, following their dreams. You don’t commit to graduate school unless the subject has significant meaning to you. They haven’t been jaded by time and they are excited to learn and grow. It’s a unique period in their lives where there is lots of energy on hand. 

So if you are under the care of a student therapist, you shouldn’t worry about her being inexperienced. There are other factors at play that make up for that. Every therapist, no matter how long he has been practicing, has something unique to offer. If you find someone who’s a good fit, it doesn’t matter whether or not she has “Ph.D.” after her name.

Have you seen a student therapist? How did it go for you? Tell us in the comments.

10 signs of mental illness you should never ignore

   

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There are a lot of symptoms of mental illness, more than anyone can list off the top of their heads. But some are more severe than others. Here are a few of the ones where you should immediately seek advice from a mental health professional. 

1. Hallucinations

Hallucinations are experiencing the presence of something that is actually not there. Visual and auditory hallucinations are the most well-known, but they can also be smells, tastes, tactile stimulation and more. Hallucinations are a symptom of several serious mental illnesses, so they should always be taken seriously. It is possible that there is a more benign explanation – it could be a lack of sleep or the side effect of a medication. But it can be difficult to judge what the  cause of a hallucination is,
                                                                                                                   meaning that a professional evaluation is called for.

2. Antisocial behavior

Antisocial behavior is not a reference to being introverted and liking alone time; rather, it’s deviating from the norms and laws of society. This often is expressed through aggressiveness, dishonesty, disregard for safety and criminal behavior. Antisocial actions can have long-lasting consequences for both the person performing them and for others, so it’s important to get it under control. When there’s a pattern of these types of behaviors, it’s important to seek help in order to prevent more permanent damage.

3. Identity confusion

There are times when people start questioning who they really are and what they want their lives to look like. Adolescence and mid-life crises are a couple examples. But if taken too far, this uncertainty is potentially dangerous. If someone suddenly abandons what was previously loved and don’t know what to replace them with, it could be a sign that something more serious is going on. At the extreme, there might be complete blank on who one is, which can be indicative of amnesia. It’s important to talk to a mental health professional to identify the cause of losing one’s sense of self.

4. Mania

Everyone gets worked up and excited sometimes, leading to increased activity in one’s life. But sometimes, it becomes out of control. If someone has persistent and abnormal elevated or irritable moods for over a week, it might be a manic episode. These episodes, a hallmark of bipolar disorder, might present with an inflated sense of self-esteem, a decreased need for sleep, racing thoughts, distractibility, being unusually productive or engaging in behaviors that will have serious negative consequences. Because of the lasting impact these episodes can have on one’s life, professional help is warranted.

5. Learning difficulties

It’s normal to struggle with learning sometimes. We are all better at some things than others. But when someone is, in at least one area, several grade levels below where one should be, it could be a learning disability. This doesn’t mean that someone’s stupid, but rather indicates a lack of the ability to learn in certain areas. Learning difficulties could also be indicative of a high level of distress, which needs to come down before one can resume regular patterns of learning. A sharp change in one’s ability, like suddenly being unable to perform tasks one could do before, should also be looked into.

6. Self-injury

Self-injury is indicative of severe distress. It often means that someone is in a lot of pain and is unable to cope with it in a healthy way. Self-injurious behaviors include cutting, burning, bruising, interfering with wound healing and intentionally sustaining injuries. While most of the time there is no intent to cause lasting damage, it might happen anyway. This is one reason why, when someone engages in self-injury, it’s important to intervene. Talking with a therapist can help in terms of finding healthier alternatives and in understanding what caused the behavior in the first place.

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7. Delusions

Delusions are beliefs that are unique to oneself and that contradict the generally accepted reality. Some examples include believing that one is under surveillance by the government without sufficient reason; thinking a song was written about oneself despite never even having met the artist; and insistence that a partner is cheating despite a complete lack of evidence. Something like believing in alien visitations or prevalent conspiracy theories are not delusions, as they are beliefs shared by lots of people. Delusions can seriously impact quality of life and might even lead to people making dangerous decisions, so talking to a professional is important.

8. Substance abuse

As discussed in an earlier post, substance abuse is highly correlated with mental illness. The two can feed off of each other, with substances being used to mask symptoms which in turn become worse due to the substances. While not all substance abuse is indicative of mental illness, it is a serious problem that should be addressed either way. It can also cause physical health problems or lead to acting impulsively in a risky way. There are lots of professionals that specialize in treating substance abuse, so find someone with experience.

9. Major shifts in personality/goals

People are generally pretty consistent in how they act and what they want. While some variations are normal, like deciding to end a relationship or to take up a new hobby, there are times when changes can be a cause for alarm. These changes are more notable when they occur rapidly. A consistently cheery person might abruptly become frequently cynical or someone may suddenly drop out of school despite indications that things were going well. It is important to take a good look at what caused these types of change, as they can be a sign of distress or mental illness. 

10. Suicidal thoughts

Thoughts of suicide should always be addressed. The risks that come with brushing it off or not seeking help are not worth it. Suicides have permanent impacts on both those who commit them and their loved ones. It’s not a decision that happens and stays in a vacuum. Surviving a suicide attempt can also lead to lasting health problems. If you feel like ending your life or suspect someone else might, talk to a professional. The earlier one gets help, the easier treatment will likely be. To learn about what suicidal people talk about, read this. I have also put together a list of hotlines, which can be found here. 

What symptoms made you seek help? Have you seen these signs in a loved one and encouraged him or her to get help? Let us know in the comments.

Make a 5-step safety plan right now

In the midst of a crisis, it’s hard to think clearly and make good decisions. That’s why it’s important to know ahead of times what to do when the going gets tough. A safety plan gives you a template for action when you are feeling suicidal, tempted to self-harm, drawn into addictions, engaging in unhealthy behaviors or feeling self-destructive. 

Having a written safety plan can be a huge help when you’re symptomatic, so let’s make one. One way of doing this is by looking at all the questions surrounding the issue. By using those five Ws, you can pretty quickly explore the many facets of staying safe. Grab a piece of paper or copy the questions into your word processor and finish this post with a safety plan in hand. 

 

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Who can I talk to?

You don’t have to go through tough times alone. Write down the people in your support system who are good listeners and who know how to make you feel better. Include their addresses, phone numbers and/or email addresses just in case you don’t have access to that information. Put a suggestion by each name stating what this person can be helpful for, like “Call my boyfriend to hear why I am loved,” or “Visit my mom to get advice.” 

What can I do to feel better?

Think about difficult times in the past and try to identify what, exactly, you were feeling and maybe even what caused those feelings. By identifying what’s setting you off, you can better find ways to manage it. Write a list of your most common triggers and a healthy way to deal with each one. This might look like “When I feel scared to go outside, I can have someone come with me,” or “When I am disappointed, I can create a gratitude list.”

When do I need to seek help?

Know your limits. Create a guide showing what to do at the different stages you might escalate through. This takes away the decision making element that can be overwhelming when you are upset. It could look something like this: “Feeling sad: Go for a walk. Wanting to hurt myself: Spend time around friends. Engaged in self-injury: Care for my wounds, then do something nice for myself. Feeling suicidal: E-mail my therapist. Actively suicidal: Call a suicide hotline or 911.”

Where can I go?

Sometimes a change of scenery can make all the difference. Make a list of places that you enjoy or that are helpful to you. While still being safe, make sure you have options for both day and night, even if it’s just a different room in the house. Some places you might want to consider are the homes of loved ones, support groups, your favorite park, a local coffee shop, the library, a scenic route for driving or even your own backyard.

Why should I not do this?

Make a list of all the reasons acting on your impulses aren’t a good idea. Acknowledge the negative consequences, but make sure to also stay positive. Having something worth not giving in for is really helpful. This could range from “I want to keep my body healthy,” to “I want to reach three months without this behavior,” or simply, “I deserve to be happy.” If you need help getting started, a list of reasons to recover can be found here.

Keep copies of your safety plan in accessible places, like in your purse, wallet, backpack, car, nightstand, comfort box and on your phone. You can also give them to people you trust who will notice when you are having a tough time so that they’ll have a guide for how to best help you. If you haven’t already been following along, I really suggest you do this. Having a safety plan is invaluable when you are in the midst of being symptomatic. It’s a lot easier to think of things now than in the moment.

What did you include in your safety plans? Is something important missing? Make suggestions in the comments.

Learning to trust your therapist

  

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It’s hard to make progress in therapy if you don’t trust your therapist. Trust is essential to the therapeutic relationship, which in turn is essential to recovery. But for many people, it’s by no means easy to open up to a complete stranger and talk about the most personal parts of their lives. This is where trust building comes in.

Your therapist has a responsibility to act in a way that makes you trust her. He has to do his part of the work to create a safe environment. But it’s not entirely up to her. There are things that you can do to build that trust, too. 

To start with, don’t be afraid to ask questions. Get to know your therapist. They have varying levels of comfort when it comes to discussing personal matters, but some questions are entirely appropriate. Asking him about his education, how he approaches treatment and what his experience has been in treating people with similar concerns. A more complete list of questions to ask your therapist can be found here. If your therapist is open to it, ask a little about her family or hobbies. This makes him more relatable, which can help build trust.

This goes the other way, too. Not everything you talk about should be symptoms and problems. Let her get to know you as a person. Tell him what you like to do and what brings you joy in your life. If something good happened to you since last time, talk about it. Therapy is not meant to be entirely depressing. You’ll feel better if you believe your therapist
                                                                                  understands you as a person, not just a problem.

Another important factor is giving feedback to your therapist. She is not a mind reader and won’t catch everything. You can let that fester into decreased trust, or you can address it as it happens. If you were upset by something he said or didn’t like how she responded to your concern, bring it up. If something was important and your therapist minimized or didn’t catch it, emphasize how much it matters to you. Talk about why you’re in treatment so it is clear that you are on the same page.

Sometimes, not trusting your therapist actually has very little to do with her. If you have other people in your life that haven’t been trustworthy, you can project your feelings about them onto him. Step back and remind yourself that they are not the same person. If this is the problem, acknowledge that the distrust comes from your end, not from something he did. Remind yourself of how your therapist has been trustworthy in the past. And by all means, talk about why you don’t trust people.

Trust is a difficult issue. Your therapist doesn’t expect it to be easy for you to establish it. Recognize your feelings about trust in your therapeutic relationship and accept that it’s normal for it to take time to build it. But believe it can change. You have to trust yourself as well. Go at your own pace and make note of when your therapist is being trustworthy. Remember those times when you find it difficult to trust her. You can even keep an ongoing list. 

Because trust is an essential part of therapy, developing it is crucial. But it’s okay if it’s something your therapist has to earn over time. Just make sure you are doing your part to move forward. Take small risks in telling him things you are concerned about his reaction to. Take bigger chances as time goes on. When you actively and openly work together on building a relationship based on trust, your progress will be worth it.

Have you found it difficult to trust your therapist? What has helped you work through that? Tell your story in the comments. 

7 signs you need a new therapist

Not every therapist is a good match for every client. This means that sometimes, finding someone else is the best thing to do to progress in your recovery. There are, of course, reasons to stay with the one you have. By working through your differences, you develop a stronger bond and learn how to manage relationships outside the therapy room. But if any of the following points are a problem, then it might be time to find someone new.

1. You are not being respected.

One of the great tasks in life is learning to get along and grow with those who are different than us. The variety of people in the world should be celebrated, as it allows humanity to reach its highest potential. But these differences can also be a source of prejudice and unkind behavior. If your therapist is devaluing your experiences, not honoring your belief system, asking you to change culturally appropriate behavior or making you feel inferior in any way, it’s time to switch therapists.

2. You can’t establish trust.

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Sometimes, we just don’t trust people. Maybe they remind us of someone that hurt us in the past or appear similar to a stereotype we have problems with. If this is the case, the first thing you should do is talk to your therapist about it. Working through that mistrust can be huge in terms of personal growth. But if you’ve tried your best and just can’t make yourself trust her, find someone that makes you feel more secure.

3. Your therapist is crossing boundaries.

Your therapist should be your therapist and nothing else. He is not a potential business partner. She is not someone you’ll hang out with at social events. He is not the friend you call at 3:00 a.m. Most importantly, she is not a romantic or sexual partner. If your relationship with your therapist is expanding into these areas, that needs to stop immediately. It’s highly unethical and could even have legal implications for your therapist. If he can’t stick to his job, find someone who can. 

4. Your therapist doesn’t respect your time.

When you go into a session, that is your hour. Your therapist should not be focusing her attention on anything but you. He should not, for example, answer calls when with you. She should also be more or less on time and not frequently canceling sessions. Be understanding that occasionally, something major might be going on. But if you see a pattern of these behaviors, you might want to look into finding someone else.

5. Your therapist breaks confidentiality.

Your therapist has to keep all information about you private. He can’t give your information to anyone, even another therapist or healthcare provider, without your permission in written form. If someone asks, she can’t even acknowledge whether or not she’s seeing you for therapy. The only exceptions are related to major safety concerns and rare legal orders, which can be read about here. But if your therapist is, for instance, chatting with your significant other about your progress without your express permission, that’s an ethical violation and a legitimate reason to dump the therapist. 

6. Your personalities clash. 

We all have certain types of people we just don’t get along with. If your therapist has a personality that is particularly irritating or difficult for you, don’t give up right away. You can become a more open and accepting person by working through those issues with your therapist. If it doesn’t work, though, it doesn’t work. On the other hand, sometimes self-improvement is secondary to an immediate concern, in which case, find someone you get along with.

7. Nothing is happening.

Progress in therapy is not as simple as a line gradually moving upwards. You’ll be all over the place. Sometimes, you’ll have a huge change for the better, while other times you’ll take a few steps back. There is some truth to the “getting worse before it gets better” concept, so don’t jump ship just because you become a bit more symptomatic. It’s part of the healing process. But if everything just stays the same, then something’s wrong and you could be better off working with someone else. 

Have you ever switched therapists? Why did you do so and how did it go? Report your experiences in the comments.

Mental health myths: Am I crazy enough?

Mental health concerns come with a lot of misunderstandings and there is plenty of misinformation out there. That’s why I like to tackle mental health myths from time to time. Today, let’s look at some thoughts about seeking treatment.

Myth: If I see a therapist, I’m crazy.

Fact: There are lots of “non-crazy” reasons to seek help.

   

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Somewhere in their heads, people set an imaginary standard for what the threshold should be for seeking mental health treatment. People come up with an idea of what they think is “bad enough.” One of the unfortunate consequences of this is that it makes people assume that someone who is in treatment meets their criteria for what they believe a mental health patient is. This is often not the case.

An acute crisis or severe symptoms definitely warrant treatment. But these are not the only reasons to seek it. It’s completely normal to go to a therapist if you are experiencing mild or moderate distress. This is, in fact, a good thing. By working on your problems before they get magnified with time saves you a lot of effort in the long run. 

It’s kind of like getting a headache. You notice that you’re hurting, but think that it’ll pass. As the day goes on, it gets worse and worse. Finally, you take some ibuprofen. But because the headache has set in more deeply at this point, it might be that no amount of pills makes it go away. You just may not feel better until after you sleep it off. Ultimately, you prolong your pain by not taking preventative action when your discomfort was tolerable. 

The same goes for staying in treatment after you start feeling better. There is no pressure to terminate until you are ready. You don’t have to stop just because you’re mostly doing better. Maintenance is important. My symptoms are not nearly as bad as they have been in the past, but I’m still in treatment because I don’t want to go back there. You might want to reduce the frequency of your sessions when you have made significant progress, but that is something to discuss with your therapist. Together you can make a decision on that.

Some people feel like they have to “earn” the right to be in therapy. They think that they don’t deserve treatment because they aren’t psychotic, don’t have a history of trauma or can cope reasonably well with their lives. The thing is, you don’t have to be a certain way to deserve help. The only prerequisite is a desire to improve your life. 

Honestly, you don’t even have to have problems to be in therapy. Plenty of people go for self-improvement. Some examples include learning to develop better relationships, finding greater fulfillment in your life, learning more about yourself and so on. You just can’t make assumptions about why people are in therapy.

In short, you don’t have to have hallucinations or be so depressed you can’t get out of bed for months before seeing a therapist. If you feel like therapy is or would be helpful for you, go for it. Likewise, don’t pass judgment on anyone else for seeking help. They don’t know your circumstances and you don’t know theirs. There is no template for what someone in treatment looks like. 

What beliefs have you had about yourself because you’re in treatment? How did you work through them? Talk about it in the comments.

Don’t put a timetable on recovery

Like most people, I entered therapy not knowing what to expect. I had dealt with depression and other mental health symptoms for years, but thought that I could take charge of my problems in a matter of weeks – a few months at the most. Almost eight years later, I’m still at it.

Assuming when I would “get better” was a mistake. The thing is, you never know. You may ask a therapist for an estimate, and they’ll often give you one. 8-12 sessions is a frequently used figure. But really, there are so many factors that influence this. There is no way to calculate how long treatment will take. 

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It is unfair to both yourself and your therapist to set a timetable on recovery. There is nothing wrong with setting goals, but don’t make hard deadlines. The mind is very complex and what’s masquerading as a relatively simple concern might actually be liked to a much larger underlying problem. You just might not see it before you examine the presenting concern. 

On the other hand, sometimes it’s faster than you’d think. I’ve heard of people benefiting from a single session. All your life problems won’t be solved in an hour, but sometimes you luck out and get the insight you need a lot quicker than expected. Really, don’t go in expecting one session to fix everything, but know that what you think might take many months or years may actually not require that much time. 

Unfortunately, insurance companies aren’t nice about letting you take as long as you need. There are often limits on how many sessions they will pay for. This means that you will want to try to make the most of your time with your therapist. Talk to her about what to do. Seeing him every other week instead of weekly can give you slower progress, but it stretches out over a longer period of time. Together you can find out what’s best for you. Also, don’t be afraid to call your insurance company if you have questions. 

Even when therapy is over, it does not mean that your progress ends there. You should not expect to be completely “fixed.” Recovery is a journey, not a destination. For many people, managing one’s mental health is a life-long endeavor. Improving your mental health is a long-term commitment. However long it takes to feel better is how long it takes. Just don’t stop trying. The “do it at home” tag is a great source for exercises to keep up your progress independently of therapy.

I know it’s hard, but don’t stress about how long your recovery will take. That only creates more anxiety and concern. Accept yourself for where you are at and be proud of yourself for any progress, no matter how small. It’s heading in the right direction that matters. Maybe you’ll feel better soon and maybe you won’t. The persistence you put in to your recovery will, however, eventually pay off. 

Are you able to be patient with yourself about the rate you’re progressing at? How did you come to peace with it?  Let us know with a comment.

Diagnosis spotlight: depersonalization/derealization disorder

We all experience dissociation in some way or another. It can be as simple as highway hypnosis, where you suddenly realize you’ve driven for miles without noticing, and as complicated as dissociative identity disorder, formerly known as multiple personality disorder. Somewhere in-between, there is depersonalization/derealization disorder.

First of all, what are depersonalization and derealization?

Depersonalization refers to a distortion in self-awareness. You are, in a sense, unfamiliar with yourself. One typically experiences detachment from the body or the sense that it is unreal. It can even mean watching yourself from outside your body. The self just doesn’t feel real and things might seem like a part of a dream. It can also be watching yourself go about your day and making decisions, but not really feeling in control. Time might also be distorted and there can be physical and/or emotional numbing. 

Derealization is when everything else doesn’t feel real. Your surroundings might feel foggy, distorted, unreal or, again, like a dream. People, places and things that may be familiar seem strange or surreal. It’s hard to fully perceive the world around yourself and it might seem like you are watching everything through a filter of sorts. It can be like living in a bubble. What is around you is very separate from you and it can be hard to fully engage in life. 

Depersonalization/derealization disorder means having episodes of one or both of these. It can be accompanied with a feeling that you’re “going crazy.” There might also be vague physical symptoms, like tingling or lightheadedness. It is often associated with anxiety and/or depression. 

Approximately one-half of adults have had an episode of depersonalization or derealization. It happens. But when it is recurring or even constant, it can become pathological. Onset is almost always before age 25, so it’s something that can be experienced from a very young age. Childhood trauma is considered one of the causes of depersonalization and derealization, but it can happen without it. Symptoms can also be caused by physical conditions or substance use, so those need to be ruled out. Episodes are often preceded by high levels of stress, anxiety, depression, traumatic events (or reminders of them) and/or drug use.

Both therapy and medication are used to treat depersonalization/derealization disorder. In particular, cognitive behavioral therapy allows people to reinterpret the symptoms and psychodynamic therapy can look at unresolved and suppressed internal conflicts. Medication-wise, nothing has been approved specifically for the treatment of this disorder, but anxiety medication and anti-depressants have shown some success. There is also research supporting the use of lamotrigine, an anti-convulsant typically used to treat epilepsy. Using grounding techniques can also be very helpful.

Having the experiences of depersonalization and derealization can be very frightening. But it is a recognized mental health condition and a notable amount of people experience it. If you feel like the symptoms described apply to you, please talk to a doctor or therapist. It is possible to gain control over it enough to where it is not interfering with your life, if it doesn’t go away altogether. 

Have you experienced depersonalization or derealization? What was it like for you? Share your experience in the comments.

5 things suicidal people talk about

    

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Being suicidal can come with a wide range of symptoms and behaviors. It will manifest in as many different ways as there are people. But there are commonalities that tend to appear. One of those is what they talk about. If the following topics come up, you may want to pry further to check on the wellbeing of the person in question.

1. Wanting to die

The idea that suicidal people don’t talk about suicide is definitely a myth. They frequently give indications of their desire to die, sometimes even flat out saying that they want to commit suicide. Saying it does not mean that they won’t do it. Sometimes it’s more indirect, with statements like, “I wish I’d just get hit by a bus.” If someone says anything at all that indicates a desire to be dead, it should be pried
                                                                                                                    into.

2. Feeling stuck, hopeless and having no reason to live

Suicide sometimes happens because there seem to be no other options. Talking about hopelessness or entrapment can therefore be a warning that the person is headed in that direction. There are always options. We may not like them, but they are there. When suicidal, though, those options can seem to disappear. This topic is an indicator that should be taken seriously.

3. Being a burden

Being suicidal can make one feel like a waste of space. Suicidal individuals might feel like they are simply a problem in the lives of others. They might think that others would be better off without them. This can be especially true when illness is present that requires assistance. If the person can’t contribute in the same way others are contributing, it can set off thoughts about the lives of loved ones being better without him or her.

4. Suddenly making big improvements

Sometimes, suicide is preceded by a significant increase in mood. The person might be a lot happier and more positive. This can come from feeling at peace with the decision to actually end ones life. Talking about how something “won’t be a problem any longer” or “doesn’t matter anymore” can stem from the decision to not be around at all. The more rapid and extreme the change is, the more you should ask questions to see what’s really going on.

5. Saying goodbye

It is normal to want a sense of closure. That’s why suicidal people sometimes go around and say goodbye to or make amends with others. It might be in an indirect way, such as, “I value our friendship and would miss it if we were away from each other,” or, “If anything happens to me, I want you to know…” The hypotheticals might not be so hypothetical after all, so it’s important to look out for these statements.

In combination with other warning signs, especially, it is important to take action. Always make sure that the person you care about has resources. There are suicide hotlines, doctors, therapists and community mental health organizations. If you aren’t sure of what to do, you can reach out to these resources as well and ask for appropriate advice. If you believe suicide is imminent or there is an actual attempt, call 911 or take the person to the emergency room. It may cause some upset in the short term, but having an angry loved one is better than having a dead one.

Have you talked to someone and worried about suicidality? How did you know that you needed to reach out?

9 things you need to believe in order to heal

Healing from mental illness is one of the most difficult things you will ever do. It’s a scary process and you never know if you’re going to relapse. But a lot of it is about attitude and belief. Here are some of the things you need to believe if you want to recover from mental illness.

1. It is possible to heal.

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There is very little point in trying to recover if you do not believe it is possible. Not believing it sets up a major barrier that makes progress in treatment minimal at best. Belief in the method of healing is essential to recovery. Take the placebo effect. If a pill that does nothing can make some people better because they believe it is something else, then believing in your actual treatment is going to be fruitful.

2. It is okay for it to take time.

At the start of therapy, people usually want to know how long it is going to take. Some people even expect everything to be solved in a single session. The truth is, it’s going to take however long it’s going to take. The average is 8-12 sessions, but that number is, in a lot of ways, completely meaningless. Whatever you need is how long it’s going to take and that’s okay.

3. It is normal to take a step back.

Recovery isn’t a straightforward trajectory towards wellness. There are ups and downs. You will get worse before you get better. And even when you do get better, you’ll still have bad days/weeks/months. The thing with setbacks is that they actually make you stronger than you were before. You may feel like you overcome it to end up in the same place, but you’ll have grown even more.

4. You are worthy of love no matter where you’re at.

Measuring our self-worth is often done by looking at our output. How well do we do in school? How much money do we make? What kind of significant other have we won over? Mental illness can affect one’s ability to produce, but it doesn’t affect self-worth. You’re just dealing with a different set of characteristics. Now your courage in facing your disorder, determination to get better and willingness to comply with treatment set you apart.

5. Others will support you if you let them.

There are others who will want to help you. And if they’re not already in your life, you will be able to find them. I spent so many years trying to recover without letting others really be there for me. I thought I had to do it myself. You don’t. Once I started letting other people in, I’ve made tremendous progress. I don’t have a big social network, but even one person supporting you makes a difference.

6. Your treatment team can help you.

Research has shown that believing in the ability of your therapist to help you improves therapy outcomes. That’s why sending someone to therapy who doesn’t believe in it or who isn’t ready is pretty useless. If you don’t entirely trust your specific therapist, look for someone else. It is critical that you have faith in those who are helping you. (Here’s a list of questions to ask potential therapists.)

7. Things are always changing.

Don’t give up on yourself because you believe you’ve exhausted every option. The world is in constant flux and your circumstances are changing all the time. There are always new treatments, new research, new therapists, new medications, new friendships, new hobbies, new everything. The belief in change is also helpful when you’re having a setback because you know it won’t last forever.

8. You are not an exception.

I spent a lot of years thinking that there was something so terribly wrong with me that I wasn’t going to get better. I put forth all my best effort with minimal results. I just thought that I was someone who couldn’t get better and that the most we could do is not make things worse. It took six and a half years of therapy to find a crucial component that turned things around. But we found it. You will find it, too, eventually.

9. It will be worth it.

Mental illness changes the way you view the future. It can be very hard to see yourself living the life you want. The truth is, things might not work out the way you’d like. I’ve worked on my undergraduate degree for eight years and still don’t know if or when I’ll get it. But I’m learning to appreciate any progress. I don’t have a lot of relationships in my life, but the ones I do have really matter. There are a few things I enjoy doing that I didn’t know about before. You have to believe that you’ll find something worthwhile, even if it isn’t exactly what you planned.

What beliefs have helped you in your recovery? Add your thoughts in the comments.

13 theoretical orientations (and what that means)

This post is part of an organized reader request series. Stop by at the beginning of each month to make your requests on the designated post. This topic was suggested by reader Julie.

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There are as many different types of therapies as there are therapists. Maybe even more. Everyone has their own style and finds particular techniques or ideas to be helpful. Even so, there are general categories of therapy. These are called theoretical orientations.

A theoretical orientation is a theory about what causes mental illness and what can be done to heal it. In graduate school, future therapists are exposed to a variety of these and find what works best for them. There isn’t one that’s inherently better than another; research has shown that theoretical orientation doesn’t significantly affect therapy outcomes. 

But some therapies will work better for some people. When looking for a therapist, you can ask about his theoretical orientation in order to assess whether he might be helpful to you. You can also ask your current therapist about hers, as it might help you understand your treatment better. Here are 13 of the more common ones.

Cognitive-behavioral therapy (CBT)

This type of therapy focuses on beliefs and behaviors. With your therapist, you look at your thoughts, feelings and actions and look for maladaptive patterns. You might receive homework to track these things. They can then be worked on using specific techniques. CBT is commonly used to treat anxiety and depression.

Humanistic therapy

This orientation posits that people naturally strive for self-actualization. It encourages self-exploration and creativity. It emphasizes that everyone can be the center of their own healing. You will look at your values and help you find your inner wisdom. The focus is on positive adaptive traits rather than pathology.

Existential therapy

In this type of therapy, pathology is seen as stemming from internal conflicts with the givens of existence. These include death, freedom and its accompanying responsibility, isolation and meaningless. The present and future is focused on more than the past. The goal is to find out how to fully live.

Psychoanalysis

This therapy was developed by Sigmund Freud, but has been built on ever since. It believes that early childhood significantly impacts ones development and that we are driven by unconscious, irrational drives. Unconscious material causes us distress, which can be handled by bringing the material to consciousness. Sessions occur multiple times a week.

Psychodynamic therapy

Psychodynamic therapy is closely related to psychoanalysis, but is less intensive and focuses more on the therapeutic relationship. Psychodynamic therapy still addresses unconscious material and internal conflicts. It acknowledges maladaptive behavior and seeks to find its root. By bringing it to light, resolution can be achieved. 

Gestalt therapy

In Gestalt therapy, the focus is on being able to fully experience each moment. It also acknowledges the interconnectedness of everyone and everything. Relationships, including that with the therapist, therefore become important. It emphasizes personal responsibility and teaches one to have a higher level of awareness.

Feminist therapy

This therapy acknowledges the difficulties one might face due to sex, gender, race, ethnicity, religion, sexuality, level of ability, age and other traits that influence one’s position in society. By recognizing these forces, one can find ways to become more empowered. A lot of emphasis is placed on the therapist and client working together as equals.

Relational therapy

Relational therapy stipulates that reality is found in relationships. A relational therapist believes that a client’s problems stem from his relationships. Psychopathology comes from disconnection or dysfunction in one’s relationships. There is, naturally, a lot of focus on the therapeutic relationship, which can serve as a corrective experience.

Family systems therapy

This type of therapy will look at families and relationships as a unit and aims to treat it. The goal is to improve relationships and the family as a whole. It takes note of different patterns in the family and offers new alternatives. It is usually practiced by bringing in the entire family, but might also be used in individual therapy. 

Solution focused brief therapy (SFBT)

SFBT is a very structured and goal-oriented approach to treatment. It doesn’t delve into what the problem is and try to analyze it, but rather focuses on what the solutions are. By looking at times when the problem isn’t present or is less severe, successful practices can be identified and utilized in the future. 

Dialectical behavioral therapy (DBT)

DBT isn’t exactly a theoretical orientation, but it is a specific type of therapy. It is usually done as a group, but therapists will pull from it in individual work, too. The focuses of DBT are mindfulness, interpersonal effectiveness, emotional regulation and distress tolerance. It was created to treat borderline personality disorder, but has proven useful for other conditions, too.

Expressive therapies

Expressive therapies are a group of therapies that use creative expression to promote healing. This might include using art making, music, dance, drama, writing and recreational activities. The focus is on the process on creation. It is often used in conjunction with psychotherapy, but can also be used as the primary treatment when appropriate.

Eclectic therapy

Eclectic therapists take elements of different theoretical orientations and put them together in an individualized way. This could, for instance, mean combining the structured techniques of CBT with a good look at existential concerns in order to address feminist issues. A large number of therapists identify themselves as eclectic, so feel free to ask which modalities are an influence.

What types of therapy have you tried? What did or didn’t you find helpful? Share your experience in the comments.

7 rights you have in therapy

  

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Because therapy can become so intimate, you might occasionally lose sight of the fact that it is also a business transaction. As the client, you have a set of rights. These also apply with psychiatrists and other doctors.

1. Right to know your therapist’s qualifications

You have the right to know that your therapist has been properly trained and is professionally competent. You can ask about his education, membership in professional organizations and standing with regards to his license. Any therapist who is hesitant to give you this information is worth investigating or dropping altogether. 

2. Right to know the limits of confidentiality

For the most part, you can tell your therapist anything. But by law and ethics, there are a few things she might have to disclose. At the beginning of therapy, you should be informed of these. It might be in your initial paperwork. If you are unsure about something, ask. You can also read the post about the limits of confidentiality.

3. Right to know diagnostic information

If you want to know any diagnostic impressions your therapist has, you can ask for that information. You are also entitled to an explanation of what your condition is and how it is treated. Don’t expect him to have this information at the end of the first session. An accurate diagnosis takes time. But as you move forward, you can check in on it.

4. Right to know your treatment plan

When treating a client, a therapist should think ahead and see where treatment is going. This is information you can ask for as well. There won’t always be a written plan, but your therapist should be able to tell you where she is going and what strategies she will be using to get there. Don’t expect a play-by-play, but you have a right to know the basics.

5. Right to have questions answered

While your therapist will probably be the one asking the most questions, you can ask for information, too. This can range from explanations of terms used to his reaction to something you said or did. When it comes to personal information, therapists have varying levels of comfort in disclosing. Respect that. But if your question is relevant to your treatment, ask away.

6. Right to be treated with respect

As intimate as therapy can get, you are also in a professional situation. You are paying for a service and that entitles you to a certain level of respect. Your therapist should not be rude, mock you, blow you off, be offensive or otherwise make you have an uncomfortable experience. While minor offenses should be worked out in sessions (read how here), a pattern of disrespect is grounds for termination. 

7. Right to have boundaries observed

Another part of therapy being a professional situation is that there are certain boundaries. Your therapist is not your friend. She should not be a business partner. And he should certainly never, ever be your lover. Your relationship should be confined to the therapy room and never be physical. Your therapist might be okay with occasional contact between sessions (email or phone calls), but that should only be about treatment.

What has been your experience in regards to client rights? Tell us your stories in the comments.

20 questions to ask a potential therapist

First sessions with therapists can be kind of like first dates or job interviews. You want to find someone who is a good fit for you, so you ask a lot of questions. Figuring out what to ask, however, might not be the easiest thing to do while you’re in the moment. Pick whichever of the following questions are the most important to you and bring a list to your fist session. It’s better to know sooner rather than later if your therapist is the right person for you to be working with.

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1. Are you currently licensed? (In the U.S., this can be verified by searching “license lookup [state]”.)

2. How long have you been practicing? 

3, What is your educational background? 

4. Are you affiliated with any professional organizations? 

5. How do you believe people change? 

6. Have you ever treated anyone with my symptoms? 

7. What did you do? 

8. Did it work? 

9. What did you learn from it?

10. Why are you working in this field? 

11. What do you consider your strengths as a therapist? 

12. What are some areas in which you would like to improve in your practice? 

13. What do you consider the most important factor for healing and improvement? 

14. What are your expectations of a client? 

15. If something comes up between sessions, what would the best thing for me to do? 

16. Have you ever had any disciplinary procedures? (In the U.S., this can be verified by searching “license lookup [state].”)

17. If yes, do you believe you were in the wrong? 

18. What have you done to rehabilitate from disciplinary procedures?

19. Would you be able to recommend additional resources (books, support groups, physicians, complimentary treatments, etc.)?

20. Do you believe you can help me?

Don’t be afraid to ask for any information relevant to your treatment. You have a right to ask questions. Any therapist unwilling to answer such questions should probably not be in practice.

What questions have you had about starting therapy? Let us know in the comments.

Finding "the one," part 2 of 2

First of all, I feel the need to apologize for this post coming a lot later than it should have. I became seriously ill last week and that inhibited me from getting it done. I'm working to build up a backlog for future incidents of that sort, but haven't gotten there yet. Thanks for your patience. :)

When the practical issues of finding a therapist have been resolved, it's time to narrow your options down based on who you want to work with. Remember that whoever you choose will be an important figure in your life, even if only for a while, so don't close your eyes and point at a random name on a list. Following are some areas to pay attention to.

The first thing you'll probably notice is personality. Now, everyone deserves a fair chance, but not everyone is going to be your confidant. If there is a trait or quality that truly interferes with your ability to fully engage in the sessions, it's worth some consideration. On the other hand, for a while I saw a therapist that seemed – no, was – excessively eccentric. It turns out that he was also extremely empathetic (and entertaining). A complaint about personality should not always be an automatic elimination, but if it keeps being an issue and it's not
                                                                                                                   something that can be addressed and solved, it                                                                                                                            might be worth looking elsewhere.

While therapists purport to be specialists in certain issues or conditions, experience can be worth much more than certification. If you are an adult male with an eating disorder, you might be better off with a clinician who has dealt with a handful of clients in the same situation than with a specialist that has only worked with teen girls. During an initial consultation, ask what the concerns and conditions the therapist typically sees in her practice. Find out if she has experience with similar issues or populations. A child therapist might not be so great with end-of-life issues. Everything's case-by-case, but use good judgment.

Similarly, talk about what techniques are used. While hypnotherapy, thought modification and biofeedback can all successfully treat anxiety, you might have a preference for one. "Theoretical orientation," or the specific theory of personality and behavior a clinician subscribes to, might come up during this discussion. This deserves (and will get) its own post, but in short, be comfortable with how the therapist conceptualizes his field. A behaviorist believes that we become the way we are through our environment, punishment and reward, etc. while an existential therapist focuses more on the larger questions in human existence and how they impact the individual.

When it comes to choosing a therapist, however, the quality that trumps all others is trust. Treatment is more or less useless – maybe even harmful – if you don't trust your therapist. You might think you're coming in for something small and relatively unimportant ("I'm having a hard time sleeping"), but keep in mind that other unexpected issues might come up ("My spouse was killed in a car accident this weekend"). Would you feel comfortable with your therapist in more extreme circumstances? Alternately, are you confident that your therapist will take you seriously when you bring up something that might seem insignificant?

You are choosing someone that you can share every single aspect of your life with, as needed. Yes, trust does need to be earned, but if you just know it's not going to happen, trust that feeling. If not, you will be more likely to withhold important information or be less willing to follow any guidance you may receive.

Closely related to trust is rapport. You are entering a relationship of sorts and if you have a hard time communicating, it's the therapeutic equivalent of a highly inquisitive person dating someone that gives one-word answers. It's just not going to work. This doesn't mean that there has to be a constant conversation. Silence definitely has its place. I was told by one psychologist that he once had a client come in, cry on his couch for an hour without saying anything, then leave. He found out the next week that it actually helped. Find someone you feel comfortable around whether you're at your best or your worst. Trying to tailor yourself to your therapist (or trying to get him to be something he's not) defeats the whole purpose of why you are there.

It is essential that you feel comfortable with whatever practitioner you choose to work with. If you aren't, find someone else. You aren't getting married! It's okay to try someone else after one session or even ten years. If a therapeutic relationship fails and you still need help, don't be afraid to move on. If you are switching therapists on a monthly basis, however, the problem might be you. Be reasonable, but also go for what you need. You deserve respect as well as treatment that works for you, specifically.


Have you ever worked with a therapist where any of these issues were relevant? Share your story – good, bad or hilarious.

Finding "the one," part 1 of 2

One of the most intimidating aspects of mental health care can be actually finding a professional to work with. If there's insurance, then only certain practitioners will be accepted. If there's no insurance, there is the added task of finding someone within one's budget or who works on a sliding scale.

Following are two effective approaches to finding a mental health professional, although a combination of both is most likely to yield the best results. There are directories and there are recommendations.

DIRECTORIES

Short and simple: There's a list of people. Search for the ones nearby. Check specializations. Choose a few to look into further.

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Outside of phone book-like listings, there appear to be two major types of websites that have names and contact information for mental health professionals, maybe even with a profile that lists personal statements and/or specifics at what each practitioner is good at. There are ones affiliated with specific associations and there are others that exist as a catalog that one usually pays to be on.

In terms of professional organizations, these will not include every single counselor or social worker or anything else in an area. But it will list its members and being a part of a respected organization is a good sign, seeing as there are criteria that must be met and maintained, usually including continuing education. Because each specific sub-field has its own groups, it can be useful to look at several different sites to get a broader range of options.

An example would be the American Psychological Association (APA). This group might be the most respected professional organization in the field. (Well, there's also the American Psychiatric Association, who are also APA. For a reminder of how psychiatrists and psychologists are different, click here.) APA's psychologist locator allows the user to search by location, gender, specializations, cultural sensitivities and so on. This locator can be found here.

When it comes to non-professional listings, there is usually money involved. This limits the amount of results. I went to one of the larger sites and my only result when including every possible type of mental health professional or clinic in a 20 mile area gave me one option – and it only dealt with a very specific population. I don't live in an unpopulated area at all.

The best comprehensive search engine of this sort might actually be the one that Psychology Today runs, which can be found here. It has very specific search options and gives more results than anywhere else I have found. In addition to standard information like that APA have options for, they can also filter for specifications such as the type of treatment, which insurance companies are accepted and religious orientation. While originally a directory of therapists, it has now expanded to include psychiatrists, group therapy and treatment centers. The profiles are also very thorough, including personal statements, cost of treatment, education, years in practice, etc.

If an insurance company will be paying for at least part of the treatment, it is a wise idea to actually call them up and insist on a complete list of professionals they are willing to work with. Usually the information packets and such only list some of the options. Cross-reference this with other directories with more information in order to get a better feel for the person.

RECOMMENDATIONS

The other route to finding a mental health professional is through asking for recommendations. While, for instance, a therapist cannot see a husband and wife separately due to conflict of interest, there are many other ways to find suggestions. Ask family and friends and have them check with theirs. Someone always knows someone. If a certain type of treatment is necessary, such as substance abuse or eating disorders, it might be worth mentioning in order to weed out the ones who mostly see clients with mild to moderate depression or anxiety.

It can be hard to admit that one needs help, though. Community organizations, religious groups, schools and the like will often have specific people they tend to work with and refer to. This is a more anonymous way of finding a practitioner. There will, however, likely be a bias based on what group is giving the suggestion.


After getting a list of names, there are still a few more things to check. It is worth seeing if each practitioner or clinic has their own website, as this can give a better feel for the options. Online reviews and ratings, if available, can be very valuable, too. I have found the best way to get these is to enter the name (in quotation marks) and state into the search engine, then adding the word "reviews" or "ratings." This should bring up any available results and saves the time of sifting through each site individually.

Another important thing to verify is licensure. This information will be available through the state itself. Searching the phrase license verification and the name of the state should bring up an option with ending in .gov. Check that the individual is actually licensed to practice. There might also be other useful information, like whether or not disciplinary action has been taken against the practitioner and when licenses expire. If working with someone who is not licensed, you have no guarantees of anything. This is how "life coaching" came about, but that is a different story.

At this point, the list should probably be fairly short. Choosing who to work with from the finalists has its own process, which will be posted on Thursday.


How did you find your therapist or one for someone else? Please share any tips on how to locate mental health professionals.