Maybe your boss is driving you crazy. Or it’s dawning on you that your husband is acting just like your alcoholic father.
Maybe you can’t find a mate, or can’t commit when you do. Maybe you hear voices, or think about suicide. Or get so scared you can’t leave home. Or so depressed you can’t get out of bed.
Whatever the particular worry, you decide the time has come to embark on that quintessentially American solution to life’s woes: therapy.
The question is, what kind of therapy and with whom?
You’ve heard, of course, of psychoanalysis, and probably of psychodynamic therapy, too, where the idea is to understand your current troubles by tracing them to the emotional patterns laid down long ago in your family.
You may also have heard of cognitive behavioral therapy, through which you try to change unproductive thoughts and actions, regardless of who did what to whom 30 years ago.
And if you’re a denizen of New Age bookstores and the bulletin boards of the granola-and-tofu circuit, you’ve probably heard of the more far out stuff as well, like rebirthing, channeling, white goddess healing, aromatherapy or – the list is endless – even alien abduction therapy.
But with therapies mutating faster than the flu virus in a bad year and options ranging from the well-studied to the wacko, you could drive yourself nuts just trying to sort it all out.
But there are some useful guidelines to navigating the therapeutic seas, say both mainstream and not-so-mainstream shrinks. Berkeley psychologist Margaret Thaler Singer, for example, coauthored “Crazy Therapies,” a useful resource for anyone interested in the less traditional options.
Ultimately, of course, picking the right therapist can be as tricky, and personal, as choosing the right mate, but here are some tips that may help:
If you haven’t had a physical exam lately, get one. There may be an underlying physical problem.
Shop around, which means visiting at least two therapists. You may be surprised how different it feels to talk to a man or a woman, to someone older or younger, to a doctor or a social worker, or someone of a different race or religion.
After each try-out visit, ask yourself how you felt. Did the therapist listen, or just try to sell you on his approach? Did she treat you with respect? Did you just plain like this person?
Be wary of any therapist who offers the first hour free. That may be a marketing gimmick, not a serious mental health consultation.
You may be attracted to both mainstream and alternative therapies, but mainstream shrinks, at least, overwhelmingly recommend seeing a licensed professional. This could be a psychiatrist (an M.D.), a psychologist, a social worker, or another professional, such as a psychiatric nurse, whose training and credentials meet a minimum standard required to be licensed by the state.
Obviously, a license is no guarantee of competence or compassion. But it’s better than no license, and it should mean the therapist has studied the basics, like how the mind works, different types of mental illness, family systems and the like.
Be skeptical, by the way, of anyone who does not have a license but hangs out a shingle as a “psychotherapist.” Legally, anyone from your car mechanic to your mother-in-law to a professional who been stripped of his license can call himself a psychotherapist.
Ask what training the therapist has had, and don’t be too easily dazzled. A few impressive-sounding weekend workshops are no substitute for years of graduate school.
Don’t pick a therapist from the phone book, a holistic health catalog, grocery store giveaways or any publication that’s mostly a marketing tool. Or if you do, at least ask for references from people who know this therapist’s work.
Be cautious about referrals from friends. A friend can be a great resource, especially if she’s no longer seeing the therapist she suggests. But in general it’s a bad idea to share therapists – you’re better off finding your own.
The best bet is to get referrals from a health professional, hospital or a mental health organization.
Steer clear of any therapist who offers simplistic, one-size-fits-all therapy that assumes everybody has the same problem. Ditto, if the explanation seems to lack common sense or be unrelated to the problem you went in with. If you have marital problems, for instance, it probably won’t help to be told you’ve been abducted by aliens or were someone else in a past life.
If you do have a specific problem, it may make sense to see someone with a defined specialty like, say, sexual abuse – though neither you nor the therapist should assume you fit this category without considerable discussion.
March right out the door if your therapist touches you – other than a hello and goodbye handshake – or comes on to you, sexually or emotionally. Some therapists feel an occasional hug is all right, but others strongly disagree.
Discuss fees upfront. Ask how many sessions insurance will cover (the state mandated minimum is $ 500). Ask if you will be billed for missed sessions. If you have managed care, ask if the therapist will fight for full coverage, which some insurers may make difficult. Avoid any therapist who offers to barter services, like giving you therapy for a picture you’ve painted.
Ask about your therapist’s orientation. Does he believe it’s important to understand the familial roots of your pain? Does he prefer to help you find ways to cope in the here and now? Think about how this approach fits with your own beliefs.
Ask what evidence there is that your therapist’s approach works, but bear in mind that many of the mainstream approaches have been found to be roughly equivalent.
A task force from the American Psychological Association recently ranked therapies according to evidence of efficacy. Some techniques clearly work, the group found, including cognitive therapy for anxiety and depression, therapy that examines interpersonal relationships in people who are depressed, and family therapy for schizophrenics and their relatives.
Other approaches probably work, among them behavior therapy for some types of drug abuse, some psychodynamic therapies and relaxation techniques for anxiety.
There’s less agreement on the efficacy of psychoanalysis, despite its longstanding reputation, or some newer controversial treatments like EMDR – eye movement desensitization and reprocessing, a technique that relies on eye movement exercises to relieve for post-traumatic stress disorder.
Be wary of any therapist who seems to be controlling you, including sequestering you from family and friends.
It’s one thing for a therapist to suggest that you not see your family right now because you are exploring possible abuse or that you steer clear of drinking buddies if you’re trying to get sober. It’s quite another to tell you to trust only him and prohibit any contact with people who are important to you.
Be open to group therapy. For some problems, this may be ideal, especially if you fear interacting with people, if you’re anxious, have an addiction or have the general sense that you don’t understand why people treat you the way they do. Self-help groups using the Alcoholics Anonymous model may also be useful.
Be wary of any therapy that leaves you feeling increasingly discouraged. It’s common to feel worse for a while when you get in touch with painful feelings, but it’s a red flag if you go endlessly downhill.
If you feel you are getting worse, discuss this with your therapist. If you are not satisfied with the explanation, get a second therapist to evaluate your progress.
Things get tricky at this point. You shouldn’t switch therapists to avoid your own deeper problems, but you should consider making a change if a therapist is not helping. This is particularly true if your therapist is not licensed or practices therapy for which there is little evidence, like “entities” therapy, in which you may be told that spirits from the dead are in your body.
If your emotional problems are severe, you might also consider prescription medications. For this you should consult a doctor, usually a psychiatrist, or a psychiatric nurse.
As you embark on therapy, give yourself credit for the courage it takes to confront your problems. And remember that many people feel they have benefited from therapy – of different kinds.
In a survey of 4,000 people by Consumer Reports in November 1995, for instance, people felt they made similar progress whether they saw a social worker, psychologist or psychiatrist. The survey also showed – the party line of the insurance industry notwithstanding – that the longer they stayed in therapy, the more progress they felt they made.
Remember that no matter which flavor therapy you choose, the key is often the relationship with the therapist.
So take your time and choose wisely.
- The sources for this story
The following people were interviewed for this column:
Anne Alonso, clinical professor of psychology, Harvard Medical School, past president of the American Group Psychotherapy Association.
David Barlow, professor of psychology and director of the Center for Anxiety and Related Disorders, Boston University.
James R. Council, psychologist, North Dakota State University, president of the psychological hypnosis division of the American Psychological Association.
Sharon Gordetsky, president-elect of the Masssachusetts Psychological Association.
Dr. Laura Kramer, a psychiatrist at Spectrum Medical Arts in Arlington, which combines Western and holistic treatments.
Robert P. Salvatore, a certified clinical social worker at LaMora Associates in Nashua, N.H., who specializes in EMDR (eye movement desensitization and reprocessing).
Margaret Thaler Singer and Janja Lalich, authors of “Crazy Therapies,” published by Jossey-Bass Publishers, San Francisco.
- For help in finding therapist
For a referral to a mental health professional licensed in Massachusetts, try the following organizations. Your choices may be limited by your insurance coverage. If you are in the midst of a mental health crisis, go to the nearest hospital emergency room or call 911.
Massachusetts Psychological Association, 617-523-6320.
Massachusetts Psychiatric Society, 1-800-831-3134.
Massachusetts Nurses Association (for psychiatric clinical nurse specialists), 1-800-882-2056).
Massachusetts Chapter of the National Association of Social Workers referral service, 617-720-2828 or 1-800-242-9794.
Massachusetts Association for Marriage and Family Therapy, 508-345-3600.
Massachusetts School Psychologists Association, 617-422-1755.
Massachusetts Mental Health Counselors Association, 1-800-944-0934. For referrals in other states, try:
American Psychological Association, 202-336-5700.
American Psychiatric Association, 202-682-6220.
National Association of Social Workers referral line, 1-800-638-8799 ext. 291.
American Association of Marriage and Family Therapists, 202-452-0109.
To learn if a mental health professional is licensed or if there have been any complaints against him or her, call:
Office of Investigations of the Division of Registration, 617-727-7406; or
For psychiatrists, the Board of Registration in Medicine, 617-727-3086.
To get a background profile on a doctor, call 617-727-0773 or 1-800-377-0550.