How to find/choose a therapist/psychiatrist

[siniang]

I agree with this! For one of my specialists, I have a nurse practitioner, and I will never go back to a doctor. NPs have a different sort of training, but they are much more likely to be willing to think outside the box AND to really listen to what you say.

Again, absolutely 100% agree for anything not mental health It was my Gyn NP after all who ordered my sleep study and who was super mindful about my anxiety/PTSD catastrophizing and ordering tests despite technically not having the indication for such tests, just because she realized it would help calm down my anxiety.

 

[whiteraven]

But are they allowed to prescribe medication, especially controlled meds?

I suspect this will depend on where you live, but yes...in most cases they can.

Also, I think my specific flavor of messed-up really needs a specific level of practical experience as well as making sure to keep up to date with the latest research (I'm not sure NPs have that time?).

Actually, knowing doctors and NPs (and ohysicians assistants PAs) both professionally and personally, I think the NPs and PAs are more willing to keep up on research than physicians.

Also, and I really truly hope this doesn't come across completely wrong and arrogant, but I do think for me in that specific case (mental health) it's better to have someone who's been through the challenges that are academia (aka have a PhD), before.

Hm...I don't believe the academic world really has any effect on a person's ability as a clinician. There are some nurses and PAs I would talk to well before I'd talk to someone stuck in what they've learned spending 8+ years studying for advanced degrees.

It sounds, though, like you have a very particular idea of what you want and need, so it's probably best to look for someone like that.

All social workers. All of them only doing online sessions.

I've had horrible experiences with social workers, so I get that. Are you completely opposed to doing online sessions? Reason I ask is because many, many therapists (of all sorts) are going online, at least part-time. My own was only going to go online during the pandemic, but he likes it so much he is likely not going back in the office.

If you don't want to do online, can you say a little bit more about that?

A lot of them significantly younger than me.

So, are you looking for an older therapist? Age doesn't bother me much, as long as I am able to connect with them, and they are competent. One thing about younger therapists is that they will have been exposed to the more recent treatments, theories, etc...in their fields.

How does anyone find a therapist, Pdoc, primary care, ... anything, if not through referrals (no choice) or recommendations from within your social circles (not an option in my case)? Good faith? Luck? Trial and Error?

Honestly? I think luck and trial and error are the ways everyone finds a "good" medical provider. Even someone who is great for one person may just not be for another.

I also have chronic fatigue and burn out and very very few spoons, and being presented with pages of pages online of Docs who take my insurance is just completely, disablingly overwhelming.

I am wondering if your insurance company or one of the social service agencies (United Way?) might have someone you can talk to to help you find a good fit?

 

[whiteraven]

I just checked my school's services. They offer Psychological (including ADHD) evaluations, and weekly therapy sessions. The eval alone is $275 and they don't accept insurance. And that doesn't even guarantee me anything because they're not requesting my medical records. Nor does it say anything about subsequent medication.

Wow, that's crazy! When I was in school (years ago, admittedly), therapy was offered free through the counseling center. They did NOT do meds, because they were psychologists, but they did refer out locally.

 

[somerandomguy]

But are they allowed to prescribe medication, especially controlled meds?

Mine does! She also keeps up on the research. None of my actual shrinks ever bothered to do that.

 

[siniang]

I don't believe the academic world really has any effect on a person's ability as a clinician.

Yes and no. I agree completely that it first and foremost does not make or not make a great clinician. However, but I meant was ... vvv

someone stuck in what they've learned spending 8+ years studying for advanced degrees.

This is not about the eduction or the knowledge they obtained but about understanding the particular level of shit and dynamics that are inherent to the academic world and that are very different to the 'outside world'. And that's the thing: someone who's never experienced this, either as a graduate student or research staff/faculty, will not really be able to understand this. Which results in approaches/recommendations/comments/... that all are perfectly fine in any other situation, but just don't work in that specific setting. For example, the stress and challenges of being a graduate student are very very different from a stressful work situation in a more regular/cooperative/private sector job.

And in my experience it needs the personal experience to really be able to understand this nuance. Which doesn't mean that those without it cannot be helpful. But those with it might be "more" helpful.

It sounds, though, like you have a very particular idea of what you want and need, so it's probably best to look for someone like that.

Yeah. She's a 5h-drive away. Oneway.

Are you completely opposed to doing online sessions?

Yep. Tried that for the past 2.5 years. Just doesn't work for me.

So, are you looking for an older therapist? Age doesn't bother me much, as long as I am able to connect with them, and they are competent.

Not necessarily older older. Just not fresh out of college. For me that's to with with their experience practicing, outside of theoretical knowledge and textbooks. Though this.... vvv

One thing about younger therapists is that they will have been exposed to the more recent treatments, theories, etc...in their fields.

are very valid points and the reason why I do shy away from those 'really old'er ones, too.

I am wondering if your insurance company

Yeah, I've been trying their website again for the last 3 hours. It's just so not helpful. You can only search for psychologist or psychiatrist, but you can't specify any specialities, and they're also not listed on the individual profiles. So you have to follow up each name with a separate google search... which 9/10 has not been fruitful because why the f*ck do none of them have any websites or any professional profiles that state their education/experiences as well as focuses and expertise/specialities?

therapy was offered free through the counseling center.

Yeah, been there, done that, not a fan. In college, we had access to free psychological student services. Which was counseling. They are equipped to help with test anxiety and your normal student life concentration and interpersonal issues, but not for anything actually clinically severe (such as PTSD). You'd have to find your own outside professional and they wouldn't refer (kinda part of the reason why it took me another 7? years after that to start therapy and receive actual diagnoses...)

 

[whiteraven]

I am wondering if your insurance company or one of the social service agencies (United Way?) might have someone you can talk to to help you find a good fit?

Yeah, I've been trying their website again for the last 3 hours.

I'm thinking you maybe didn't understand what I was saying. As in my quote above, I wasn't suggesting to look through the website yourself, but to locate a person to talk to who can navigate that for you?

Or maybe I misunderstood?

 

[siniang]

I think I partly misunderstood, my apologies.

I'm with a MAJOR insurance provider... I assume they'd only direct me to their website or will be using that same database. If anything, I guess my best bet would be contacting my school's mental health services, which I will probably do later.

While searching, stumbled across a dedicated ADHD&Autism "center" .... which puts big emphasis on ABA.

Yeah, another big fat NOPE.

Switched gears for a bit (I found *one* therapist that sounded ok, who's currently only offering telehealth) to go look for a PCP ... which really is just same same but different but still the same. I just posted in my diary: I really know why I was with Kaiser and liked being with Kaiser all this time. It's so much easier (for people like me).

 

[joeylittle]

What I'm also wondering...previously, my PDoc didn't really do therapy. We only had 20 minutes check-in sessions and if at all talked about medication needs/adjustments. So I *had* to have both a PDoc and a T. I'm not sure if that is standard or whether other PDocs actually also do (talk/EMDR/...) therapy? I just don't know enough about any of that, I guess.

Aka, do I need two again or could I try to find a good (trauma-focused, neurodivergent-focused,...) PDoc and just skip the T? Especially considering that I'm not actually particularly interested in medication, actually? But need the ADHD meds, so "just a T" isn't exactly an option, either?

I don't think I saw anyone reply to this part of your thread....It's fairly unusual to find a Psychiatrist who works with adults and also does therapy. Psychiatrists who also do therapy tend to specialize in adolescents.

Another web resource that I've been impressed by is GoodTherapy (GoodTherapy - Find the Right Therapist) - the difference between them and psychology today seems to be in the cost to the provider (to be listed) and the vetting process they undergo.

It's always been a trial and error process for me - taking recommendations from people I barely knew, internet searching...pretty much anything and everything. In the end, I got to the psych and therapist I have through a PHP. Psych recommended therapist for one city I was in, then recommended another when I moved; and the psych was someone I had worked with a lot and trusted. But before her, there were two not-good psychiatrists. And after her, about three failed psychs before getting to my current one.

I've been curious about this new health care system called forward - it's scattered throughout the US. I really don't know anything about it except that it seems to be something one pays into, so I don't know how it intersects (or if it is compatible with) traditional insurance plans. Just tossing it out there.

Because I'm no longer in a closed system where T and PDoc directly work together, I feel like this is almost redundant, as I suspect they wouldn't necessarily inform each other and then I basically have to work on the same things, twice, just with different approaches because necessarily PDocs and Ts *are* different on many levels?

How it works for me: My psychiatrist has always been necessary, that's where I'm getting the anchor for depression management. Therapist is more specific to PTSD, but also helps with depression, crisis management, anxiety, etc, etc. They co-ordinate about once a year at this point. I don't find them to. be redundant, but I suppose that's because I see the therapist 2x a week and the psych once every 4-6 weeks.

You might look into whether Psychologists can obtain prescribing powers in your state; that's a good way to get someone who can do therapy and also do medication. But, not all states allow for it.

I'm sorry it's so hard - just to validate what you're going through, there's nothing easy about finding the right doctors.

 

[siniang]

Thank you @joeylittle! I looked into both your links, unfortunately with no luck whatsoever. GoodTherapy provided even fewer results and the second one I stopped halfway through because I just couldn't shake the feeling of it being rather click-baity and almost scammy (even if it's not).

I don't know if I mentioned it here or only in my thread. I had emailed a psychologist - who sounded like a perfect fit but who's unfortunately many many hours away - asking for recommendations. They actually replied with literally one name locally and who's like one of *the* national experts. He's also on the older side and I have not yet reached out to them asking for recommendations (because at this point I doubt they actively practice). Quite too intimidated.

I emailed my schools psychological services for recommendations and services they provide and have not heard back.

I did find *one* other psychologist who sounded ok and who has even practiced in Hawaii for a while. But they don't take my insurance.

It's also like I really have to make a decision whether I want someone specialized in trauma or specialized in neurodivergence as the few I do find in online data bases only ever have either or in their conditions list. But it's important for me because for me one really does inform the other and vice versa.

So yeah, zero progress.

Also just recently learned the actual semantic difference between a "therapist" and a "psychologist", though I don't really have a good handle on that yet when looking up profiles.

Right now it seems like the best way forward is to find a good PCP and a psychologist und hoping the psychologist can provide prescription recommendation to the PCP; not sure if that's even possible.

Seriously, having everything in-house at Kaiser was so frigging much easier I can't even wrap my head around how this is not a more common thing.

 

[siniang]

Right now it seems like the best way forward is to find a good PCP

Since I want a PCP who takes my fatigue seriously, I'm not sure whether I should go with your random family medicine doc or look for one specialized in internal medicine? Can those even be PCPs or do they always end up being family medicine docs?

 

[somerandomguy]

In the USA, internal medicine doctors are almost always family doctors/PCPs.