PodTherapy

Hi there, a few points in response to your post.

1. Re: Stalled Treatment - The big picture you seem to be describing is what we call "treatment resistant" symptoms. Its when a person has tried all that is recommended (therapy, medication, etc) but despite managing their symptoms they don't see much success overall. This can be exhausting for you and the Clinicians, as we want to see you get better too. When this happens I usually tell the patient that I want to take a "kitchen sink" approach, really becoming open minded to throwing everything we can at the problem. Changing up medications (with the supervision of a Psychiatrist), making significant life changes, and changing some of our therapeutic focus. The key from your perspective is to be willing to keep going through the stagnation, and being willing to try new things even if they seem like they won't be valuable.
2. Re: What Therapists Can Do - I actually think Therapists are a big part of fixing the IRL problem, though I know what you mean that we can't reach into your life and touch the presenting issue ourselves. I also believe that humans can and do change (or I'm in the wrong damn business) and that you too are experiencing incremental and sporadic change as you go through therapy. Sometimes what we are doing in therapy is managing, stretching, like doing a weekly emotional yoga session. If a therapist can't dislodge the other problems in a persons life at least we can help them cope with their troubles, which is itself extremely valuable.
3. Re: Suggestions - I'd hate to just spam you with treatment suggestions, but I'll be brief. First, dont give up. Never give up. Even if you are just managing, that is success. Even if you are just slowing the symptoms down, that is success. Know that you are making progress, even if that is invisible. If your therapist says they can't work with you that can be for a variety of reasons, sometimes insurance, sometimes they don't feel qualified. That's ok. Just ask them for referrals and follow up with a new therapist. Your job is to keep trying, keep doing, keep going, no matter what. I also encourage you to look into support groups with your local NAMI Chapter, and you might also want to look into EMDR work for trauma.

In elementary school I'd like kids to learn to use meditation techniques to self-soothe when they are feeling overwhelmed or stressed. In Middle/High school I'd like kids to learn some basic cognitive behavioral therapy techniques to equip them for times of anxiety or depression. Both sets of techniques are big on confronting a perspective we *think* is happening and challenging us to see it in a new light. Young people face so many new challenges these days - especially due to the self-comparing, passive bullying, and less-than-ifying effects of social media - they really benefit from having tools to develop new perspectives to keep them mentally healthy.

Hi Eyelashchantel! Great question!

So a couple of thoughts on this.

1. If you aren't progressing - regardless of the core cause - I want you to discuss this with your therapist. Alot of people are nervous to bring this up, but one way you could is to ask if you can discuss your goals and treatment plan with them. Then share that you feel stuck, as if you are not making gains. Then ask if they have any ideas to help you keep moving forward. Your therapist might give you some perspective you hadn't noticed, or they might have some materials they didn't think youd be into, or they might bring up a therapist change (Ive done this lots of times) or they might give you some feedback about areas that maybe they have asked you to try things but you haven't been willing to.
2. For decades the science has told us conclusively that the greatest predictor of patient outcomes is not the modality used, but the relationship with the therapist. Lots of people overthink the method (CBT, EMDR, DBT, etc) but really they should be focused on the connection she share with the therapist. If #1 above doesn't help, I'd consider a new therapist, but dont give up and don't feel that you need to swap therapists every time you feel stuck - sometimes stuck is part of the process.

Hi there! Thanks so much for supporting us! A few thoughts:

1. Re: Group Therapy - Depending on the situation, therapists like group therapy for a variety of reasons. The power of a peer to reveal our own attitudes, biases, and blindspots is so important to a person's ability to grow. A peer can say things you relate to that you might never hear from a therapist, and watching a peer find success in their own work might inspire you to imitate them which is great. But to be clear, group therapy is not something we recommend for every single thing, its something that is very useful for certain conditions. Refusal to participate is normally seen as against clinical advice if you are in a program (drug/alcohol rehab, psych hospital, intensive outpatient, etc). That is because at those levels group is considered a higher level intervention and if you refuse and opt instead for a lower level (like one on one therapy) it is sort of you declining the care that your team believes is in your best interest. There are lots of reasons for why group is often a higher level of care, mostly it has to do with the time we spend with you and the information we can share with you, along with accountability. But I totally understand your point, group can often feel redundant and it is greatly influenced by the participation of its members. That can make it a really difficult experience to control and keep high quality.
2. Re: Intake - When we do intake sessions we are typically looking for a lot of things. Firstly, our take away goal is to understand you. To begin the process of getting you. We want to get a feel for how you think, what matters to you, how you see your life and your situation, what you've been through, and what you want to see going forward. More specifically we are also looking for (a) the presenting problem (b) the history of this problem in your life (c) other issues that are important to know about like life trauma, medical issues, other mental health issues, (d) your history of health care experiences to date (e) your family history and what you grew up in (f) your life presently, who you live with, your relationships, your job (g) other relevant details as they arise. Some therapists are formulaic in their intake sessions, asking about all the above in a straightforward way. I prefer a conversational style. My patients usually don't even realize I have a list of things I'm looking for, I like to just make it a getting to know you conversation and gather the details naturally.
3. Re: Personality Disorders - I'm touchy about PDs because I believe more often than not they end a conversation rather than opening one. Declaring somebody to have Narcissistic Personality Disorder or Borderline Personality Disorder can sometimes put a label on them that doesn't help. The connection between trauma and the development of these PDs is well known, and I'm more often interested in addressing the traumatic underpinnings than labeling the relationship styles they find themselves in.
4. Re: Society Insights - Yes, being a therapist has given me a private viewing window into the inner feelings of our species. Humans are basically good. Their intentions are good, their motivations are good, they generally mean well. Humans are also basically selfish, which is not in and of itself immoral. They tend to make choices that feel good and avoid things that hurt, often that can confound the people around them and cause all types of trouble. When humans develop good insight into their patterns, they tend to use that information to grow. Being a therapist causes me to see global political struggles very differently, and I have a nuanced view of society in general.

You did it! You asked the golden question! I hope this gets upvoted alot.

So I expected this question and blogged about it in anticipation, but here is a quick rundown of how to find a therapist.

Will you be paying out of pocket?

1. Search Yelp, Google or Psychology Today to find therapists in your area. All therapists take out of pocket patients, pick whoever you like.

2. Search for telehealth therapists if you are comfortable with that, I’ve been practicing telehealth for the past 2 years and I can honestly say the difference is minimal.

Do you have insurance?

1. You may have a phone number on the back of your insurance card to call for mental health care.

2. Go to your insurance’s website and download the “provider list” for mental health. Start googling the names of providers and see if any of them are a good fit.

3. Go to PsychologyToday.com and search for therapists by Zip code, filter those results by your insurance. You can also filter by specialties, but keep in mind most therapists are competent to treat most things and will tell you if they aren’t, so don’t over think it.

Are you or your spouse/parent employed?

1. Contact your Human Resources department and ask if your company has an “Employee Assistance Program” (EAP). You may receive access to a therapist completely independent of insurance.

Uninsured and Unemployed?

1. If you have your states insurance (Medicaid etc) then contact them for the provider list or search Psychology Today. It isn’t the case that Medicaid therapists are lesser in quality, there is usually no difference.

2. Search therapists in your area and filter by rate they charge. You’ll find many therapists are in their “Intern” years, this is sort of like a learners permit, they are practicing therapy under the supervision of a master therapist. These are great lower rate options. You can also contact therapists and ask if they have a “sliding scale”, this means they will charge some patients less if there is a financial difficulty.

3. Contact your state Universities and ask if they have a program where graduate students practice counseling. These are usually nearly free for patients and exist so therapy students can get hands on experience.

4. Are you religious? Contact your church and ask if they have any options. Often religious institutions have lists of professional therapists they partner with and are happy to pay the bill for.