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feedmyleg
Dec 25, 2004

EVERY FAIRY TALE NEEDS ITS HERO.

I've been stuck with an "I have to do it myself and I can't ask for help" mentality throughout my life. I also have a ton of personal areas in which I want to grow and change and evolve. I've been stumbling in the dark for years trying to work through these issues on my own, but, well, it turns out I'm terrible at it. And I'm sick of trying to do it alone.

Luckily, the crushing loneliness and never-ending introspection of quarantine came along and I've finally admitted to myself that in order to get where I want to go in any reasonable amount of time, I'm going to need professional help. However, due to my aforementioned mentality, I've either consciously or subconsciously avoided learning anything at all about therapy throughout my life. To the point that I'm so ignorant that I find all of the information out there wildly overwhelming when I try to approach the subject. And even though I have many friends who currently go to therapy or are connected to that world, the degree of my ignorance feels embarrassing to the point that I'm (stupidly) hesitant to discuss it with them.

So, here I am, asking for help. Mainly I'm interested in three areas, 1) Logistics of finding the right therapy type, finding the right therapist, and figuring out how that works with my insurance and what my options even are in that regard, 2) The basic things that might be useful to know going into this situation totally unprepared otherwise and without a great foundation of emotional tools, such as what sessions tend to look like, how to approach bringing certain issues up, where to start, etc., and 3) What would be the best way to get started during the global pandemic? I know there are plenty of tele-health startups out there that offer online therapy, but I have no idea if that would be a good option for someone who would prefer to establish a trusted relationship with a therapist and work with them for the long-term. If it's the only option right now and I have to use it as a stopgap, then I'd love to know which of those services are good and how I should approach them. Also, I live in NYC so if I was able to find someone locally that would be ideal so that I could transition into more standard therapy sessions after the pandemic I'd prefer that.

If it's relevant, the sort of stuff that I want to work on deals with opening myself up to emotion, pulling back on selfishness, strengthening personal relationships, reversing bad anxiety coping mechanisms, etc. Just general personal work, not necessarily tied to a specific traumatic event or situation, and not (necessarily) with an eye toward getting medication or any particular issue. I feel like something that's long-term, pragmatic, and solution-oriented would appeal to me.

TLDR, what should a person who has little understanding around therapy know in order to start getting help?

feedmyleg fucked around with this message at 21:55 on May 12, 2020

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Crotch Fruit
Jul 1, 2007

ASK ME ABOUT
CRUSTING MY
JORTS OVER THE
INTERNATIONAL
FEMINIST LEGO
AGENDA


I am far from an expert, but from what I know there are two types of therapists - couples, and individual therapists. The individual therapists might be more specialized, like one person might do testing for personality disorders, or someone might be licensed to prescribe medication that others might not be licensed to prescribe. You might find someone who specializes in a certain type of therapy, like someone good with aspergers or autism, but every therapist should have some understanding of all disorders even if it is not their specialty.

With that in mind, I hate to sound blunt or like I'm not listening to you, but honestly the first step should be to find out who or what your insurance covers and then go start talking to a therapist. The big first question is be whether you want individual or couples therapy, and that is easy to answer. From there, at your first appointment your therapist is going to ask what you want out of therapy. Are you depressed? Talk about what is depressing you and how to improve it. Are you anxious? Talk about ways to cope with your anxiety. Are you willing to take medications? Medication is not required, although it may be encouraged, and might even just be temporary while your dealing with hard times. I believe they can even do genetic testing to determine what type of drugs might help you the most. Growing up, I had it beat into me that medication and anti depressants were terrible and only made people suicidal, but even with my background I cant deny the possibility that modern medicines can great when prescribed responsibly.

You might find that you really like the first therapist you go to. Or you might find they are not really working, like if you have Asperger and go to an autism specialist, but they can (or should be able to) refer you to someone who does specialize in your needs. Starting therapy can be a long, slow process and there will be times when you love what your therapist says, and times when you disagree. My only advice would be if you think you might have disorder, ask for testing, and similarly if you think you might need medicines, ask if testing is an option if you want to go that route. I believe testing is likely expensive and thus something therapist might try to avoid. Maybe they can in fact make the perfect diagnosis without testing, but if you want testing by all means ask for it. As for therapy in the pandemic, ask your insurance company if they are covering telemedicine sessions otherwise your going to drive to the facility and let them hose you down externally with Lysol when you step through the door, or whatever their decontamination procedure is.

And for the love of god don't seek out Tony Robbins unless your rich. That's my shameless plug for my own thread.

feedmyleg
Dec 25, 2004

EVERY FAIRY TALE NEEDS ITS HERO.

Thanks for the detailed answer! Once I get to a therapist the rest of that sounds like great advice, but it's a bit beyond where I am right now. This:

Crotch Fruit posted:

the first step should be to find out who or what your insurance covers and then go start talking to a therapist.

is honestly the thing I'm having trouble with, as silly as that sounds. How do I "go start talking to a therapist"? My insurance provider's website lists "Licensed Professional Counselor" and "Clinical Psychology" as provided services, but I don't even know if that's the same thing as what I'm looking for. I don't know, like I said I'm embarrassingly ignorant on the whole subject—it's an entire area of adult life that I've actively avoided learning about. Maybe I was sort of asking the wrong question and needed to take an additional step back, but this more of an "explain it like I'm 5" kind of scenario. I also rarely go to the doctor (might have medical anxiety?) so maybe I just lack the basic skills and understanding of how to do this that most people developed much younger.

feedmyleg fucked around with this message at 13:06 on May 13, 2020

Numerical Anxiety
Sep 2, 2011

Hello.


The simplest way to go about it would be to look up via your insurance company's website, what therapists in your area they'll cover (Clinical Psychologists, LPCs, LCSWs, LMFTs are the various kinds of therapists - the degree might matter less than what they actually practice). You'll probably want to look those people up online, see what they specialize in, how they present themselves, what it is precisely that they do. Do they focus on particular kinds or problems, or do they favor one method or another? Do they prefer long or short term treatments? Their websites should give you some idea. When you have an idea of which you might prefer, start making calls - ask them if they're taking on patients and if you can schedule a consultation - don't be surprised if some of them tell you that they already have a full caseload and aren't taking on any more people - that's not uncommon. If it happens, it's not you.

Then you go for a consultation, which gives you and the therapist a sense of who each other are and if you would like to work together. It might also involve goal setting, which is going to depend on your needs and also how much time your insurance might give you. Are they giving you eight sessions, twenty, or as-needed? What one can reasonably expect to do in eight is very different from one can do in thirty sessions, and you'll decide together what is reasonable to try to accomplish in that time. If you're feeling good about the meeting, you schedule further sessions, and things go forward, but don't feel obligated.

Nessus
Dec 22, 2003

I still can't believe they cast Spock as me. Spock! Can you imagine?

Of course, he was missing a few things.



feedmyleg posted:

Thanks for the detailed answer! Once I get to a therapist the rest of that sounds like great advice, but it's a bit beyond where I am right now. This:


is honestly the thing I'm having trouble with, as silly as that sounds. How do I "go start talking to a therapist"? My insurance provider's website lists "Licensed Professional Counselor" and "Clinical Psychology" as provided services, but I don't even know if that's the same thing as what I'm looking for. I don't know, like I said I'm embarrassingly ignorant on the whole subject—it's an entire area of adult life that I've actively avoided learning about. Maybe I was sort of asking the wrong question and needed to take an additional step back, but this more of an "explain it like I'm 5" kind of scenario. I also rarely go to the doctor (might have medical anxiety?) so maybe I just lack the basic skills and understanding of how to do this that most people developed much younger.
If you want to PM me your insurer's page I can look around because they probably have someone you can contact for more information, at least as of right now.

My best advice is to think of this as a mixture of just another kind of doctor, and as someone passing on specialized coping skills (even if the training may be very personalized). That might help you get your head round it and stay in the game. It may not bring quick results, there may be setbacks, but if you'd been in a wheelchair for six months, you wouldn't put yourself down if you took a little bit to go jogging, right?

Scudworth
Jan 1, 2005

When life gives you lemons, you clone those lemons, and make super lemons.



Dinosaur Gum

how to find a therapist: Psychology Today maintains a god drat massive database of practitioners by location who have registered to it, you can search by all sorts of criteria including insurance -- https://www.psychologytoday.com/us/therapists
They all offer video now, because they have to. Once you decide on a few you'd like to talk to, you can email them or leave a phone message and they'll probably set up a time to chat on the phone to answer any questions and you can see if you have a good feeling about one to start with.

Bollock Monkey
Jan 21, 2007
The Almighty

I'm not in your country so can't help with certain aspects, but:

Sessions tend to last 50 minutes and, depending on the modality, are generally a space to talk about whatever is on your mind. You might have discussed certain topics that you want to cover, or maybe you had a lovely week and want to talk through some of the things that came up... It's really up to you. But your therapist can ask questions or guide the conversation, if you think that would be helpful. It is useful to have that discussion with them - some styles are about leaving silence for the client to fill/to give time for you both to reflect, others are more directed, that's something you will figure out between yourselves.

Regarding bringing up certain issues, you just sort of... Do? You mention it, you say what you are thinking. The way to get the most out of therapy is to meaningfully engage with the process, and the basis of that is honesty.

As an example, my therapist and I tend to start with a "Hi, how's it going, how's the week been?" and from there maybe I say "Actually not a lot has come up this week, it's been pretty good..." and we will perhaps choose to reflect on something that is a long-standing feature of my life rather than something more acute. Another time I might say "My week's been ok but on Wednesday my partner and I fell out over the washing up and it really ruined my mood for the evening," and we'll maybe pick apart what led up to that, what else had been going on, how to deal with the situation better next time. Because of her approach she always checks in about how I have been doing with validating myself. There might be consistent things like that, which perhaps you don't go in to every time, but that you both keep tabs on.

In terms of where to start, you will probably have an initial assessment and an initial meeting with your therapist. Go into those with an idea of what, broadly, you'd like to work on. Take the last paragraph of your post and just read that out verbatim if you want. Over time you will delve into various things at various times, and maybe you'll spend a couple of weeks focusing around one thing but then something happens another week that really triggers your anxiety or whatever, and you'll talk more around that specific situation.

The first few sessions feel sort of odd but as with any relationship, comfort develops over time.

Therapy is also no short fix. You're not going to feel the benefit after a couple of sessions. And good therapy can make you feel really lovely before you start feeling better. It's important to stick with it even when you really don't want to go - unless of course that feeling is because you are not getting on at all with your therapist. Studies have shown that the type of therapy is far less important than the relationship between client and therapist. Give someone a go for a few sessions and if you really don't vibe, find someone else.

I don't think distance therapy is a bad thing. With the magic of video calling you can still begin to build the relationship, even if it is a bit different to being fully in person. There's never a bad time to start therapy, and if you're feeling motivated towards it I would very much recommend taking the plunge.

Everyone should have therapy, in my opinion. It's a good space and we all have stuff we could do to work through with a neutral party.

For super pragmatic stuff, maybe look into CBT-based approaches. I personally think it's also good to have some space to just talk stuff through alongside the skills building, and though CBT isn't the best thing for everyone, it's a good place to start - especially when you want to get more skills to help you cope with anxiety as it's pretty well indicated for that.

Jacobus Spades
Oct 29, 2004

Oh wow!

I can certainly understand that feeling of having to do things for yourself with no help. Accepting that there's merit in reaching out for help is a huge first step and one that you should feel good about. If it helps you reconcile, most talk therapy nowadays is what's called "client-centered" therapy, meaning that the therapist serves as an informed guide to help you come to your own conclusions about your feelings. In other words, even if it feels like you don't know where to start or where you're going, with the therapists help you will hopefully arrive at your own uniquely meaningful answers. It's one of those things where you very much get out of it what you put in, so any progress you make will be your own.

As for providers in your area, rather than looking yourself I'd start by giving your insurance a call directly. They can generally help you find providers in your area that they partner with based on the provider's given areas of expertise. Some specialize in certain age groups for example, while others may counsel for specific life changes or events. It might sound like you need to have a tailor fitted therapist, the truth is that most therapists, unless they specialize in a particular technique such as gestalt therapy (if you've ever seen the confrontational style sessions on TV or in Movies it's characteristic of that), should be able to help with whatever areas you're wanting to work on. Unfortunately a lot of practices tend to have few openings so you'll likely have to call around to find availability, but if a provider has a spot they can usually accommodate regular appointments for the foreseeable future.

As far as things to know in advance.... I don't there's too much prep needed, although it certainly helps to have a clear idea of what you'd like to work on just to keep sessions moving forward. Think of it this way: there are a lot of people who begin therapy either not knowing what it is they need to work on, or thinking that one thing is a problem and eventually coming to a completely different conclusion as they explore their thoughts and feelings. It's not really something you can plan for, and those types of steps in therapy tend to arise as the therapist helps guide you through the topics and feelings you bring up. In the best cases it's an organic process that helps you organize your thinking while helping you develop productive coping mechanisms and strategies to approach problematic situations.

Most courses of treatments take place as weekly appointments for... however long you feel you need them. The first session might be a little awkward or underwhelming but this is normal - think of it as a calibration. The therapist will often ask broad questions and might not have a lot of advice for you right out of the gate, but in subsequent sessions when you both have a better idea of what it is that's going on and what you want out of therapy things tend to go more smoothly.

If you're ever unsure of what to talk about your therapist can make suggestions. Often I'll not know exactly what it is I want to talk about with my therapist but I don't think I can name a single session I've had where I didn't get something out of it.

I think another important thing to know for someone who's not familiar with therapy is that therapists, like any medical professional, adhere to a strict code of patient confidentiality. If there's anything you're afraid of sharing, just remember that they legally can only talk about it with the people disclosed on your intake form that you authorize. Typically this is their peers in a professional context, but you can release other parties to discuss your case if it's needed (such as your primary care physician if, say, the therapist believes it might be helpful to know your medical history). The one exception to this is if it's about a crime, but that will be outlined in the intake form.

The most important thing to keep in mind though is that you get out of therapy what you put in. This means being responsible for putting into practice any "homework" your therapist has for you, finding ways of making it relevant to you even if it seems like it isn't, being open and honest when your therapist asks you questions, and allowing yourself to be introspective and objective even if your therapist asks you questions or offers an opinion that seem to question your feelings or beliefs. It might seem contradictory, but one of the tools in a therapist's kit can be to push your buttons a little to help you think about things in a different way. This can also serve as a check - you are free to defend yourself and your positions, but in doing so it's important to offer a convincing counterargument. If you can't it might be worth re-examining those beliefs.

One more tip - while the client-driven approach often avoids giving direct advice, instead preferring to guide a patient to a conclusion so they themselves can arrive a personally satisfying answer, there's nothing saying you can't ask your therapist's opinion. Just keep in mind that they can't give you the answers you seek, only help you to find them.

I can't speak to what specific providers are doing to deal with pandemic-related difficulties, but I can say that even my relatively small local office is doing tele-health conferences now so I imagine that it won't be hard to find a provider that can accommodate. It's no substitute for in-person counseling in my opinion, but if you have a device that can do video chat it's a decent option.

Good luck!

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feedmyleg
Dec 25, 2004

EVERY FAIRY TALE NEEDS ITS HERO.

This has all been incredibly helpful so far, thank you all. At this point I've been exploring the in-network therapists who are accepting new patients and cross-referencing them with their Psychology Today profiles to get a sense of who might be a good match. Once I've narrowed them down I'll be contacting 3-5 of them to see what kind of responses I get back. It's still taking me a lot longer than it might take someone without avoidance issues, but I appreciate everyone's support and advice and assisting in nudging me toward getting help.

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