How to Find the Right Therapist and Get the Right Diagnosis | Find a Therapist That is Right for You

Hey there, everybody, and welcome to this presentation on finding the right therapist and diagnosis for you. I'm your host, Dr. Donnelly Snipes. In this presentation, we're going to talk about where to find a therapist, what to look for in a therapist, why a good connection with a therapist is important, and how to effectively communicate your situation. Start with the easy one. Where do I find one? Well, a lot of places, a lot of companies, especially larger ones, have something called an employee Assistance Program that you can access by going to your human resources department. The EAP or Employee Assistance Program, often will offer three to 10 sessions for free. It's something that it's a benefit that your company has and a way to get some brief therapy, if you will. Now, if you don't have an employee Assistance program or you think it's something that's going to require more than brief therapy, you can go to Psychology Today's Therapist Locator. This is not a comprehensive list of every therapist in your area. Therapists have to pay to be on here, but you can get an idea of their approach and the issues that they treat and the insurances that they accept at a quick glance so you can look and see and get a feel. This doesn't mean you're going to necessarily love the therapist that you pick out, but it gives you something to go on instead of just blindly looking at a map and going, I'll pick that one. You can also, if you feel comfortable, try to get referrals from friends, family, or even your pastor. A lot of times, pastors and clergy and rabbis work with people on issues, but then they get to a point where the person needs more mental health assistance or counseling than they feel prepared or trained to do. And they may have a list of people that they work with very closely in the community. So if you do go to a church or a synagogue, you might explore checking with Your Spiritual Leader, Unitedway.org or 211 is a national database of all kinds of things, all kinds of resources, and they are able to provide you information about therapists in your area, particularly ones that operate on a sliding scale or accept Medicaid and have low cost options. United Way is really a place to go to when you're looking for resources that are free or low cost. Some communities will have free clinics. United Way is most likely to know about those. So again, this is somewhere where you can call and get somebody that has access to that computerized directory that can help you. Lastly, SAMHSA.gov, the Substance Abuse and Mental Health Services Administration.gov find treatment this is another one that lists some of the agencies in your area, but not all of them by any means. Most of the agencies that are listed on the Fine Treatment website are ones that accept state funds funding Medicaid funding. The nice thing about this is you can look for intensive treatment for mental health or substance abuse. You can search by the whether they take Medicaid, private pay, sliding scale. They don't have people who are in private practice. All they have are to the best of my knowledge, looking at in the states that I've looked at, all they have are agencies that provide services. But if you've got a prominent insurance or Medicaid or Medicare, this might be a good way to start looking for a therapist. Ultimately you can also just google and find something like find therapist near me and look at Google Maps. But then you're really flying blind trying to figure out who might be a good fit. Most therapists have a website and or a Facebook page that you can go and look at to get a better idea of the populations they serve. But there's a lot more to finding a good fit. So let's move into that. What to look for affordability. You don't want to start therapy with somebody and go for two sessions and then not be able to afford it anymore. You want to see if you have insurance. Do they take your insurance? If you are on something like Medishare, check and see. They may have I know Medishare offers free counseling via the telephone, 30 minute sessions and I don't think that there's a limit on them. I could be wrong there. So check with your insurance company about what their what services they do cover, what services they do offer. Remember with insurance you've got a deductible. So if you have not met your deductible you're still going to be paying out of pocket until you meet that deductible. Therefore, even if insurance, even if counselor Sally takes Blue Cross and Blue Shield and you have Blue Cross and Blue Shield, so woohoo. But you have not met any of your $5,000 deductible, then you're going to be paying counselor Sally's full rate until you have already paid out $5,000. So it is important to understand how your insurance works which takes us to sliding scale and private pay. A lot of places offer sliding scale rates for people in order to try to make it more affordable, recognizing that most people people don't meet their deductibles each year and as a result most people are going to be paying out of pocket, so they would rather do a sliding scale and not involve insurance at all. That's up to you. Accessibility is another thing. What are their hours? If you work Monday through Friday 8 to 4 and your clinician works Monday through Friday 9 to 5, there's very little time where you won't have to take off work to go see that person. And if you work a job where you don't have leave time, if you're not there you don't get paid, that can be a big deal. Many therapists either have evening hours in office or evening hours via telehealth, but it's important to check and make sure. Is this someone that's going to be able to offer me appointments that I can actually make? Location is also an issue. How far away is it for me? Where I live? I live about 30 miles outside of Nashville and if I were to select a therapist that's down in Green Hills, that's an hour and 20 minute drive with Nashville traffic just one way to get to that person's office and then, you know, another 30 minutes to try to find parking, that would be way more stressful to me than choosing somebody else. So it's important to consider the travel time, the distance, the hassle associated with it is are you going to end up canceling a lot of your appointments because it's just too stressful to even get there? You also want to consider the approach and you didn't go to school to be a counselor. I don't expect you to know a lot of the approaches. Cognitive behavioral therapy is one of the most prominent approaches, one of the ones that's been most consistently studied, and it is helpful for a variety of issues for a lot of people, but not for everybody. Cognitive behavioral therapy helps you explore your thoughts, your beliefs in response to things in your life, and how it affects your emotions and affects your behaviors and affects your health. Cognitive behavioral therapy tends to be very active and directive in nature, so your therapist is going to be asking you questions and encouraging you to explore things. Psychodynamic focuses on how does your past influence the way you perceive the present? So psychodynamic and CBT sometimes go together. If you are not interested in exploring how your past impacts your present, then psychodynamic may not be for you, person centered or humanistic. Now this is what most clinicians are taught in college to the exclusion of everything else, unfortunately. And humanistic is great to the extent that it really helps develop rapport in a person centered, humanistic session. It is very non directive. The goal is to create a safe, secure, welcoming environment for a person to explore their thoughts and beliefs with the understanding that when provided a secure environment that people will naturally unblock themselves. As I said, that's much less active and directive. So it tends to take longer for people to really start seeing and feeling significant differences. Not always, but most of the time. From my experience, EMDR is a much newer therapy than the other ones, but it has been shown to be extremely helpful for people with trauma and issues related to their trauma and traumatic memories. It helps them unhook the traumatic reaction, the stress reaction from the traumatic memory, and it helps them process that trauma in a way that their brain can get it out of the amygdala, if you will. And that's again grossly oversimplified. But EMDR has been shown repeatedly to be very, very helpful. However, it's also like many of these other approaches will require at least 10 sessions. Eclectic is something that a lot of people, a lot of clinicians will say. My approach is eclectic, which means they use different tools for, for different people and different disorders. Which is great. It's great to have a lot of things in your toolbox. But my question to a therapist who says I'm eclectic is okay, this is me and this is my presenting condition. How do you generally go about treating anxiety, depression, ptsd, whatever it is that you have and get an idea of what their approach is. They may say, well, typically I start with a humanistic approach to develop rapport and then we use a lot of cognitive behavioral interventions. Okay, that's good. But if they can't articulate their process, not so good. You also want to look at their specializations. If you have a, I wish I could say run of the mill anxiety or depression, but non trauma related mood disorder, you may be less concerned about specializations. I don't know. However, if you've experienced trauma, then I would recommend looking for someone who says they are trauma informed. They've been trained in trauma informed approaches, which means they recognize the wide reaching biopsychosocial impact of trauma. They recognize how trauma impacts the body and is stored in the body as well as the mind, how it impacts your relationships, your mood, the way you perceive the world. It's important if you've experienced trauma and it is currently negatively impacting you for your therapist to be aware of that so they can make sure that they are doing things that don't re traumatize you. And on the other end they actually empower you to Feel safer and more in control of what's going on. If you have an addiction or an eating disorder, these are very specialized areas that require specialized training. Now the state doesn't require specialized training, but in order to adequately treat addictions or eating disorders, it's really important that the therapist has taken particular trainings on them. Kink aware if you are involved in BDSM or kink involved relationships, it's helpful to be seen by a therapist who is kink aware. Those that are not kink awareness may pathologize kink related behaviors or may attribute some of your presenting issues to the kink related behaviors when they are not related to that at all. And I have a few videos on kink and bdsm on the YouTube channel, but I did want to bring that up to let you know that there are kink aware therapists out there. You just have to, you have to look sometimes veterans is another population that may have special issues because of their exposure to violence and what they have gone through when, when they have been deployed. It's not the same. It's just, it's not the same. So there is, there are special techniques that can be helpful and special issues that you need to be aware about aware of when working with somebody who has, has worked in a military structure. There are a lot of other examples, however, these are just some of the more common examples of specializations that I think are important. Child is another one. If you are looking for a therapist for your child, make sure that you find a therapist who has been trained in working with that age group. Working with a 5 year old is different than working with a 12 year old, which is different than working with an adult. So it's important that that therapist understands the physical and cognitive development and appropriate interventions. Transparency is something else you look at. Are they open to telling you, are they up front about how much each session costs, the expected treatment duration? If they are cagey about how long you're going to be in treatment or how long it generally takes before you, before people with your particular diagnosis start experiencing significant improvement, I would be cautious. It doesn't mean that if people generally experience significant improvement in 10 weeks that that's necessarily going to be true for you. But you want to at least have a ballpark of, you know, where is the end of this tunnel? Where's the light at the end of this tunnel? And not think, well, it could be two months, it could be two years, who knows? Their experience addressing your particular issue also needs to be transparent to you. Have you Ever worked with this? Have you had specialized training on this? The American Counseling Association Code of Ethics actually states in the code of ethics that people who are counselors are required to disclose in the initial session in the informed consent for treatment the nature of all services to be provided, whether that's individual counseling, group counseling, family counseling, couples counseling, drug testing, whatever it is, the nature of the services, the purpose, goals, techniques, procedures, limitations, potential risks and benefits of all services, as well as potential alternatives. If the person says, yeah, no, that's not for me. What are some alternatives? The counselor's qualifications, relevant experience and approach. Okay, that's in the code of ethics. That is required to be ethically required to be in the informed consent, the fee and billing arrangements. Again, I said you need to find it out. You need transparency. But ethics says it's supposed to be there. The right of the person to participate in the development of treatment plans. And this is so important. Too often I see clinicians either not create a treatment plan or create a treatment plan without input from the person served and then hand it to them and say, okay, sign this. That's not okay. That is not okay. Unless the person served is not capable of processing what's going on, that's not okay. So recognize that you have the right to be an active participant in your treatment. Imagine that. And you have the right to refuse any services or changes and be advised of the consequences of such refusal. When might this occur? Generally, the only time there's consequences of refusal is if the person is court ordered and they refuse to comply. Then the therapist will have to say, well, I'm going to have to tell your probation officer that you refused to comply with treatment or you didn't do a drug screen, or if the person is actively suicidal or homicidal and the therapist is encouraging them to check themselves in for crisis stabilization, and they are refusing to do so. And. And the therapist believes that it is. They are an imminent danger to themselves or others, then the consequence would be involuntary commitment. There may be some other occasional things that come up where there are consequences for refusal, but most of the time, at least in my practice, you know, we're talking and something comes up with a particular treatment issue, and I say, what about trying this? The person has. I encourage them to say, yeah, I'll try that. That sounds interesting. Or let me think on it. Or maybe flat out, no, no, not. Not going for that. Okay. You know, just because I suggest something doesn't mean you have to buy into it. And the therapeutic alliance, your ability to be. Ability to feel safe, heard, respected, and supported, or empowered. Whatever word you want to use in the session accounts for up to 80% of the change process. Well, why is this? Because in order to become vulnerable, you have to feel safe. In order to explore what's triggering your distress, you have to face feel safe. You don't want to make yourself vulnerable in a situation that is unsafe. If you're not feeling safe, heard, respected, supported, empowered, it may be helpful to resolve this issue by discussing it with your therapist. I suggest that to people, especially if they've been going to a therapist for a while, and the therapist, they just don't seem to be clicking. Sometimes they're not clicking because the therapist is not reading them correctly and they are not assertively saying, that's not working for me, or I'm not feeling heard, I'm feeling invalidated. Addressing this with your therapist is easier said than done. No matter how hard we try as a therapist to create an environment where we are equals, it doesn't happen that way. There's always somewhat of a power dynamic. And a lot of times when people come into counseling, they struggle with self esteem, assertiveness, fear of abandonment, fear of rejection. You know, there's lots of reasons why people may be terrified of, of being assertive. If you want to keep that therapist and you feel safe addressing it, then it can be very helpful. It's a great place where theoretically it's safe to practice this skill and address this issue. Because there are going to be people outside of therapy that invalidate you, may make you feel unsafe or disrespected, and they don't intend to. And if you bring it up to them, they're like, oh my gosh, I'm sorry, you know, I didn't realize. So it can be useful rehearsal for those situations. But especially at the beginning of therapy, you may not feel safe or comfortable doing that. And it may be necessary to seek a different therapist. Yeah, it's your call. It's always your call. You are empowered. You are paying this person, you are hiring this person to help you. If you hire a mechanic to fix your car and they're not getting the job done, then you're going to find a different mechanic. Diagnosis can be somewhat complicated, and no two people will receive the exact same treatment. I see two people with the major depressive issues. They may have different symptoms, or they may have the same symptoms, but respond to different treatments because their symptoms are caused by different things. So it's important to recognize that the therapist actually has been trained in a lot of different medications, modalities and a lot of different things that may be triggering or causing your symptoms. And some diagnoses require specialized testing like adhd, especially if you're trying to get a psychiatrist to prescribe medications. However, it is vital that the provider is willing to hear your perspective on what you think is going on. If you think you've got major depression, if you think you've got bipolar or ADHD or whatever it is, it's vital that your provider is open to hearing your perspective. What you think caused or triggered it, and what you think may or may not be helpful. You may go in there and go, I've tried CBT before or I've learned about CBT and I don't know, I don't think so. Or emdr. That's just too New Agey. Don't want to go there. Okay. You know, the therapist should be respectful of that and recognize that your right to help direct your treatment. A culturally sensitive trauma informed therapist will likely ask your perception Other helpful tips Get a Physical it's really helpful sometimes even before going in to see a therapist to get a physical to rule out any underlying hormonal or nutritional or sleep related issues that could be contributing to your symptoms. Most therapists are not trained in the physical causes of mood and cognitive symptoms, so they may not be aware of the impact of hypothyroid or vitamin D deficiency or anemia or some of those other things that can all cause symptoms that look very much like depression. No matter how much talk therapy you do, if you've got hypothyroid, you're not going to get a lot of improvement. So it's important to address the underlying physical issues. And some would really vehemently disagree with me here, but I found it to be extremely helpful for myself as an individual as well as as a parent. Google the diagnostic criteria for the condition you believe you have. If you're talking about mental health issues, Google the DSM criteria for each listed criteria identify your related symptoms. For example, if you think you've got major depressive disorder, one of the criteria for major depressive disorder is sleep changes. So you may say I have sleep changes as evidenced by difficulty falling asleep. I'm sleeping for less than four hours, then I'm waking up and unable to get back to sleep. And this has been going on for the last three months. Okay? That would be very clear evidence that you are having sleep changes that coincided with or slightly came slightly before your mood changes. These are really helpful because it fast tracks the Assessment for the therapist. It gives them something to work with. Now, there are a lot of symptoms that overlap in different disorders. So they may major depression overlaps with bipolar disorder and some other things. So they may still ask you some questions and not just take you at your word. Okay, you've got major depressive disorder. What next? It's important that they use their years of training in order to make sure that your diagnosis is right. What I do, and again, not every therapist does this, but what I do is I will actually get out my DSM 5 TR is actually online, but I will get out a copy of the diagnostic manual if I think there's another condition that the person may have. And we'll go through the criteria and I will ask them, you know, does this feel like it fits why or why not? And we arrive at a mutual understanding of what's going on. Know what has, has and has not worked for you. What have you done to try to address the situation? A lot of times you don't just wake up one morning and you're in the middle of a major depressive episode. It started coming on and you tried to address it. You tried to do something. Maybe you've been depressed for a while. What has helped, even if for an hour, what has helped? And we can build off of that. That's called a strengths based approach. And what do you think might help? A lot of times, especially in the day and age of the Internet, people have already gone online and tried to figure out how to fix themselves. And if there's something that you think might help an approach, it's important to feel like you can bring that up to your therapist and say, hey, I learned about this online. I learned about this, you know, from a book. And I'm wondering if it might help me, if it might work for me. And hopefully the therapist is receptive to that. If they get defensive, you know, that is on them. I'll say that again. If they get defensive, that is on them. They're taking it too personally that you dare contradict them. That's not a good sign. However, it's important in the way you present it. You don't want to go, you've been doing this all wrong. The book says to do it this way. That might provoke some defensiveness. However, if you go in and say something like, you know, I really feel like we've stalled out, or I'm stuck, or I'm not progressing very fast and I learned about this, I'm wondering what you think. Oh, that's different. You know, that's a more assertive perspective. You're not saying you're wrong, I'm right. You're saying, these are my thoughts. You know, what are your thoughts? I also encourage you to recognize that you have a right to an explanation if a therapist will not try an intervention. For example, if you want to try EMDR and the therapist says, yeah, no, they may not be trained in it, and so you have the right to an explanation for it and possibly a referral. I am not certified in emdr, so I will not use it with my. With my patients. However, I have made many referrals to people who are certified in emdr. It doesn't mean that my client goes over there and stays over there forever, although they may. But my job ethically is to make sure that the person is getting the best treatment for them. So your therapist may refer you to an EMDR therapist or a massage therapist, or an acupuncturist, whatever you're requesting in addition to their services. That's okay, too. I encourage people to keep a journal or log of your symptoms for a week or more prior to your appointment so you can produce evidence. These are what my symptoms have been. This is how frequently, how intense they've been. To give your therapist a good idea of what your life is really like right now and then continue to keep that journal throughout treatment so you can see incremental progress or no progress at all. And if you're not seeing progress, you can make an informed decision about what to do next. Do you bring it up with your therapist and try a different technique or a different approach or different testing? Or do you switch therapists altogether? What's going to. What do you think the best next step is? Even if there's a good connection, you may really like your therapist. If you don't feel like you're making progress, it is okay, a hundred percent okay to ask for a strategy change or even a referral to another therapist. Again, an ethical therapist is going to recognize that our job is to make sure that you are getting the most effective treatment at any point in time. And if that's not us, so be it. It may be that you just don't respond to the techniques that I've been trained in, but you may respond really well over here. And it's important to, for the, for the person, for the patient to recognize that it is okay to do this. And if your therapist gets upset, irritable about it, that is on them, and that is their responsibility to deal with their feelings of rejection. Or whatever they're feeling, but it is your right to seek effective treatment. Not every therapist is a good fit for every person or every diagnosis. Ethical therapists are open to collaboration with the person and are aware of the limits of their competence. That means they don't treat things for which they have not been adequately trained. Connecting with a therapist can be scary because you're making yourself vulnerable. If you don't feel safe, heard and respected, then it may not probably not be a good fit.