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How do you find a therapist?
Your endocrinologist will know the names of some therapists. Usually he or she will give you two or three names. You can call each of them and see how they sound. Before you ask for a referral, think about the type of person with whom you would feel comfortable. You may prefer a therapist who is female rather than male (or vice versa), who is of a particular ethnic background or faith, or who has a particular therapeutic orientation. If you have children, you may prefer a therapist who has raised children. If you are gay or lesbian, you may prefer a therapist who is gay or lesbian. Don't hesitate to ask your physician for the type of person you want. You can also ask the therapist these questions. Don't be put off if the therapist says, "Why do you want to know?" It may seem obvious to you, (and annoying to be asked) but I can tell you from the therapist's end that this can be the beginning of a very fruitful discussion.
A lot of physicians are pretty sophisticated about feelings and about therapy. You can tell them whether you want someone who is more of a behavior-change person, or more of a traditional "talk" therapist. Perhaps your physician has an intuition about your liking someone he or she knows. Not every town has a therapist who knows about diabetes, but you can ask your physician if one exists.
Diabetes teaching nurses and dieticians are also good sources. Therapists in your community may give talks or classes from time to time, through hospitals, community colleges, diabetes associations, or other groups. Go see what they are like, and if you think they seem like the type of person you would like to talk to.
You can tell a therapist that you would like to come and meet them for a one or two session consultation. You can tell them you've never talked to a therapist before, and would like to talk with them about options - what you are looking for, etc. You will be expected to pay for this consultation, but you may be more comfortable talking with a therapist about what you want, or asking a therapist about your options, than "plunging right in" with a person whom you are just meeting for the first time.
I have often done a "two session evaluation" with a prospective patient. They tell me why they are coming in - what is troubling them. If it seems that we get along well, we decide if we can arrange a fee, and a time to meet. Sometimes I feel that someone else can help them better than I can; for example, perhaps they have severe anorexia and I would like to refer them to someone who specializes in this area. Or perhaps they decide that they would like to see a male therapist, or would like me to find them a certain type of therapist who is closer to their home. (I am in Los Angeles, where driving distances can be great!)
A therapist should be comfortable telling you about his or her training, and approach to therapy. You are entitled to know these things. On the other hand, the therapist may not want to tell you the ages of his/her children, where they go to school, or where s/he lives. There are reasons, down the road, why the therapist may not want to tell you much information about him/herself.
Paying for psychotherapy
If you ask, a therapist should be willing to state his/her fee over the telephone. A few therapists do not charge for the first evaluation; others charge more for the first session because they make it longer so you have more time to talk. You can find out whether you will be expected to pay the therapist directly and then submit statements to your insurance company, or whether the therapist will be willing to bill your insurance company.
Do your homework first. Unless cost is no issue, check to see if you have insurance coverage for psychotherapy. If you do, look carefully. Do you have a certain number of sessions covered? What happens if you exceed that number?
Sometimes your insurance will cover only people in certain specialties, such as a licensed psychologist (Ph.D. and must be licensed as a psychologist) or licensed social worker. So, before you go see someone, you want to make sure you understand what your insurance will and won't cover.
There are also many community clinics that offer excellent psychotherapy at reduced fees. You may want to find out what they offer – short-term (up to how many sessions?) therapy? Group therapy only? Longer term therapy? You may want to ask whether you will be assigned to a therapist who is in training, and what the degree of experience the therapist is likely to have had.
You can phone the psychology department of any college near you and find out whether they train psychologists and offer lower fee therapy. Medical centers are also a good resource for psychologists, psychiatrists and social workers. They may also have someone who specializes in working with people with diabetes, or other chronic medical conditions.
Perhaps you will find out that your insurance company will only pay for six psychotherapy sessions per year. Six sessions is sometimes useful for therapy directed at getting over a crisis. But, if you have six sessions of therapy and don't feel a lot better, that is not your fault. If you feel that you would like to make some major changes in your life, or you are depressed and miserable, six sessions just isn't much therapy.
If you think you would like to be in longer term psychotherapy but know that you can't afford it, you have a few choices. You can look for a therapist at an institute where psychoanalysts are trained. At these institutes, the people in training are already licensed therapists working in the community. They have decided to become psychoanalysts. To become a psychoanalyst, the therapist must see a certain number of patients for a certain number of years. He or she is already a licensed therapist and is getting this training to enrich his/her knowledge and become an even better therapist. He or she will consult regularly with a highly experienced psychoanalyst, who may provide suggestions helpful to your therapy. You would have at least 3 appointments a week, and perhaps 4 or 5, so you have to have the time and interest for this!
How do I tell if a therapist is good?
In the best of all worlds, you have been given the name of a therapist by someone who knows a lot of therapists, and knows the person to whom they referred you. But, let's say you are depressed and you're not feeling better after several sessions.
Hmmm. This is a tricky situation, because if you are depressed, it is going to take more than several sessions before you start to feel better. Your situation didn't happen overnight, and it will take time to improve upon it. On the other hand, perhaps you and the therapist are not the best match.
A complicating factor is that some of the best therapists may act a little warm but kind of neutral toward you. It can get you wondering "What's she thinking?" "Does she not like me?"
Well - in certain types of training, the therapist is taught to act this way. There are lots of reasons for this that perhaps I will add to the site in the future. Some therapists are also shy! But they also don't want to impose their personality on you, so they hold back a bit. Give it a little time.
The other complicating factor is that many people are worried that people don't like them. If your therapist isn't talkative, does that mean she doesn't like you? You can ask her. She may not answer your question, but you can watch and see how she responds to it - and how you do, too. In therapy, you should be able to talk about anything. (Most therapists will not discuss their personal lives - their children, husbands, etc., for reasons I may go into in another version of this website!) If you can't, you've found the wrong therapist.
So, do the following:
Trust your gut.
You should feel that the therapist is listening carefully to you
The therapist should have a psychotherapy license of psychiatrist (MD), psychologist (Ph.D.), social worker (MSW, LCSW or other abbreviations in other states), or marriage and family therapist (MFCC or MFT). The therapist should be willing to respond to questions about her/his training.
The therapist should also feel "professional" to you. The therapist should treat you respectfully and be careful of your privacy and careful about your needs – for example, not keeping you waiting beyond more than a few minutes past your appointment time, unless something unusual is going on.
A therapist should show interest in you personally
Therapists do not usually give much advice – there are exceptions such as when they are truly concerned that you may be doing something that could be dangerous or have a negative lasting effect
What should you not expect?
1. Many therapists will not see two people who are friends with each other, each in individual therapy. That policy prevents a lot of problems: what if the two of you have a major disagreement? each will wonder what the other is saying. There may also be some jealousy. There are other reasons why this is not a good idea. Similarly, a therapist will usually not see a person with whom he or she has a prior relationship or a current social or business relationship . This is not a law, but a good ethical principle. For example, I would not see my neighbor, or a parent of a student in my child's class. I would not see the mother of a friend. More privacy and a more formal relationship make for better therapy. In small towns, sometimes this cannot be avoided.
2. The therapist is bound to uphold the confidentiality of anything you say in a session, unless you are a danger to yourself or others, or reveal physical abuse of children. The exception is if you sign forms that allow disclosure to others, such as your insurance company or your physician.If someone in your office processes insurance forms, s/he will probably find out that you are seeing a therapist, and may have access to your diagnosis.
3. The therapist should never approach you sexually.
What if the therapist comes well-recommended but you are not happy with him or her?
Try to talk about it with your therapist.
If you are still uncomfortable, or are more uncomfortable, you may want to meet another therapist. A therapist can be highly trained, have written several books and be famous, but not right for you and your personality.
But you also can't expect miracles. Most everyone goes into therapy hoping that if the therapist will only understand his or her problems correctly, that the therapist will know exactly what to do about them. If the therapist doesn't tell them what to do, the therapist must be hiding that knowledge - or be mean and unwilling to give it. In reality, if your problems were simple, you probably would have solved them already. There is rarely a quick "magical" solution to a problem that has been developing over a long period of time.
Therapy is frustratingly slow. Change will come, but it may take a long time. You may also be in psychological pain and just want it to be over with. (A good example is bereavement - you just want the pain to end.)
It is a good idea to bring your feelings about therapy and about the therapist TO the therapist. If you are irritated with the therapist, if you didn't like what they said to you last week, if you thought they looked bored, TALK about it. These are not typical things most of us are taught to do in our families. But, if you have the courage to bring up these feelings with your therapist, you have a lot to gain from the discussion. Your therapist should be open to talking about all of your feelings. That's our job.
SO, HOW DO YOU FEEL ABOUT SEEKING PSYCHOTHERAPY?
What does it mean to YOU to be seeing a psychologist or other therapist?
Many people are afraid of walking through a therapist's door.
"Does this mean I'm crazy?" (No.)
"Does this mean I'm weak?" (No. You had the guts to get there.)
"What has my life come to that I need to talk to a therapist?" (Maybe some good things await you.)
"What if a therapist tells me I'm beyond hope?" (Don't go back to that therapist.)
It takes a certain amount of bravery to walk into a therapist's office. It also can open up wonderful doors of opportunity for you. Psychotherapy can help you understand so much about yourself. Therapy does take time. It can be frustrating to finally get brave enough to call, get an appointment and finally come in -- then your problems don't magically disappear. The therapist may be rather quiet, and when you ask, "Well???" at the end of the session, the therapist may tell you that she doesn't know you well enough to say much, but that she would like you to come back so you can talk more.
This can be frustrating! But, a good therapist will not try to provide a "quick fix."
Except for some staunch behavior therapists, all therapists will be interested in your thoughts and feelings about coming in to talk. Also, almost all therapists will be interested in your reactions to them - positive, negative, and everything in between. Remember, good therapy takes time. If you are dissatisfied with your progress, talk to your therapist about your feelings. Therapy is about learning new ways of interacting with yourself, others, and your environment. One good way to start is to talk with a person who should be open to talking with you about just about anything, including your relationship.
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